Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2025; 31(20): 104038
Published online May 28, 2025. doi: 10.3748/wjg.v31.i20.104038
Upadacitinib for ulcerative colitis and pyoderma gangrenosum in a patient with schizophrenia on long-term risperidone: A case report
Sheng-Duo He, Yu Tian
Sheng-Duo He, Yu Tian, Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
Author contributions: He SD followed up the patient and wrote the manuscript; Tian Y diagnosed and treated the patient, organized clinical data, participated in discussions on dermatological diagnosis and treatment; all authors have read and approved the final manuscript.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu Tian, MD, Chief Physician, Department of Gastroenterology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China. tianyu@medmail.com.cn
Received: January 22, 2025
Revised: March 27, 2025
Accepted: May 7, 2025
Published online: May 28, 2025
Processing time: 126 Days and 17.2 Hours
Abstract
BACKGROUND

Pyoderma gangrenosum (PG) is one of the most severe extra-intestinal manifestations of ulcerative colitis (UC). The treatment of refractory UC combined with PG is challenging, particularly for patients with schizophrenia (SCZ) with a long-term history of risperidone use, and there have been no successfully treated patients reported in the literature.

CASE SUMMARY

A 36-year-old woman attended the gastroenterological clinic due to intermittent symptoms of diarrhea and mucous bloody stools. Prior to the emergence of these symptoms, the patient had a history of SCZ for 3 years. She had been receiving long-term risperidone treatment and had stable mental symptoms. In April 2023, she was diagnosed with UC E3 moderate and began taking mesalazine 3 g/day. In March 2024, her intestinal symptoms recurred and approximately 2 months later, PG developed in both lower limbs. Previous treatments with adalimumab and steroids were ineffective for PG and UC, and simultaneously, the patient experienced headache, confusion, and severe sleep disturbances. After switching to upadacitinib (UPA) 45 mg/day, PG lesions showed complete healing and fecal calprotectin was < 10 μg/g after 7 weeks of treatment. Following approximately 12 weeks of UPA therapy, colonoscopy indicated that the patient had achieved mucosal healing. No adverse events occurred during UPA induction and maintenance therapy for 6 months with risperidone.

CONCLUSION

UPA treatment led to successful resolution of both intestinal and extra-intestinal manifestations in this patient with new-onset UC who had a history of SCZ. No adverse effects were observed with concurrent UPA and risperidone use.

Keywords: Ulcerative colitis; Schizophrenia; Risperidone; Pyoderma gangrenosum; Upadacitinib; Case report

Core Tip: Due to the potential anti-inflammatory effect of risperidone via the tumor necrosis factor pathway, patients with new-onset ulcerative colitis (UC) who have been receiving long-term risperidone cannot achieve a good therapeutic effect with anti-tumor necrosis factor therapy. We report the successful treatment of a patient with UC combined with pyoderma gangrenosum using upadacitinib, with no adverse events during the 6-month follow-up period.