Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Dec 7, 2008; 14(45): 7012-7015
Published online Dec 7, 2008. doi: 10.3748/wjg.14.7012
A subset of ulcerative colitis with positive proteinase-3 antineutrophil cytoplasmic antibody
Jin Xu, Chuan-Hua Yang, Xiao-Yu Chen, Xu-Hang Li, Min Dai, Shu-Dong Xiao
Jin Xu, Chuan-Hua Yang, Xiao-Yu Chen, Shu-Dong Xiao, Department of Internal Medicine, Division of Gastroenterology, Shanghai Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
Xu-Hang Li, Department of Medicine GI Division, Johns Hopkins University School of Medicine, Baltimore MD 21205, United States
Min Dai, Department of Internal Medicine, Division of Rheumatology, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
Author contributions: Yang CH designed the research; Xu J, Dai M performed the research; Chen XY reviewed pathology; Xu J, Yang CH analyzed the data and wrote the paper; Li XH and Xiao SD revised English.
Supported by National Natural Science Foundation of China, No. 30570829
Correspondence to: Chuan-Hua Yang, Department of Internal Medicine, Division of Gastroenterology, Shanghai Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiaotong University School of Medicine, 145 Shandong Zhong Road, Shanghai 200001, China. yangchuanhua@yahoo.com
Telephone: +86-21-63200874 Fax: +86-21-63266027
Received: September 4, 2008
Revised: October 26, 2008
Accepted: November 2, 2008
Published online: December 7, 2008
Abstract

A small subset of patients with active ulcerative colitis is non-responsive to major known non-biological therapies. We reported 5 patients with positive serum proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANCA) and tried to (1) identify the common clinical features of these patients; (2) investigate the efficacy of a novel therapy using a Chinese medicine compound; and (3) attract more gastroenterologists to be engaged in further study of this subset of patients. The common manifestations of disease in these 5 patients included recurrent bloody diarrhea and inflammatory lesions involving the entire colorectal mucosa. Initial treatment with intravenous methylprednisolone successfully induced remission. Four of these 5 patients were steroid-dependence, and immunosuppressants, such as azathioprine and cyclophosphamide, were ineffective. In 3 patients, only the particular Chinese medicine compound could induce and maintain remission. One patient underwent colectomy. No vascular inflammatory lesions were found by histopathological examination. Although more cases are needed for confirmation, our study indicates that ulcerative colitis with positive PR3-ANCA may belong to a subtype of refractory ulcerative colitis. The particular Chinese medicine compound used in our study is by far the most effective in the management of these patients, with additional advantages of having no noticeable side-effects and less financial burden.

Keywords: Refractory ulcerative colitis; Proteinase-3 antineutrophil cytoplasmic antibody; Methylprednisolone; Steroid-dependence; Chinese medicine