Rare extraintestinal manifestations of ulcerative colitis treated with dual biologic therapy: A case report

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.