Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2024; 12(23): 5441-5447
Published online Aug 16, 2024. doi: 10.12998/wjcc.v12.i23.5441
Rare extraintestinal manifestations of ulcerative colitis treated with dual biologic therapy: A case report
Aleksandra Filipiuk, Maciej Gonciarz
Aleksandra Filipiuk, Maciej Gonciarz, Department of Gastroenterology and Internal Medicine, Military Institute of Medicine–National Research Institute in Warsaw, Warsaw 04-141, Poland
Author contributions: Filipiuk A, Gonciarz M contributed equally to the entire work on the article: Patient treatment planning, substantial contributions to conception and design of the case report, data gathering, or analysis and interpretation of the data, drafting the article or making critical revisions related to important intellectual content of the article, final approval of the version of the article to be published.
Informed consent statement: Informed consent was given by the patient.
Conflict-of-interest statement: We have no conflict of interest to declare.
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: Aleksandra Filipiuk, MD, Doctor, Department of Gastroenterology and Internal Medicine, Military Institute of Medicine–National Research Institute in Warsaw, Szaserów 128, Warsaw 04-141, Poland. afilipiuk@wim.mil.pl
Received: April 27, 2024
Revised: May 29, 2024
Accepted: June 20, 2024
Published online: August 16, 2024
Processing time: 68 Days and 15.9 Hours
Abstract
BACKGROUND

Ulcerative colitis (UC) is an idiopathic, chronic inflammatory bowel disease (IBD) most often located in the rectum, but may involve the entire colon. Extra intestinal manifestations (EIMs) occur with varying frequency depending on the affected organ. The most common ones are musculoskeletal EIMs, affecting up to 33%-40% of IBD patients. These include, among others, inflammatory back pain, tendinitis, plantar fasciitis and arthritis. Only a few case reports in literature discuss Achilles tendinitis.

CASE SUMMARY

This report describes a patient with UC and Achilles tendinitis in whom after many unsuccessful attempts of treatment with sulfasalazine, mesalazine, glucocorticosteroids, infliximab and tofacitinib, a complete UC remission and resolution of Achilles tendinitis were achieved with the use of dual biologic therapy (DBT)-ustekinumab and adalimumab (ADA).

CONCLUSION

This case mentions rare EIMs of UC and suggests that DBT may be an alternative for patient with ulcerative colitis and EIMs.

Keywords: Achilles tendinitis; Dual biologic therapy; Extraintestinal manifestations; Spondyloarthropathy; Ulcerative colitis; Case report

Core Tip: Achilles tendinitis is one of the rarest extra intestinal manifestations of ulcerative colitis (UC). To our best knowledge only a few case reports in literature discuss this problem. This article is a case report of a patient immobilized by Achilles tendinitis and excluded from social life by a very long-lasting exacerbation of UC. His way to recovery was full of ups and downs. We tried many lines of biological treatment with no permanent success. Only dual biologic therapy with ustekinumab and adalimumab thanks to combining two mechanisms of action brought the desired effect–a steroid free remission of UC and Achilles tendinitis.