Management of ulcerative colitis pre- and post-liver transplant for primary sclerosing cholangitis: two case reports and review of literature

摘要

Thirty one-year-old female with a history of moderately severe pan-ulcerative colitis and primary sclerosing cholangitis (PSC), She had been diagnosed with PSC 8 prior to presentation after presenting with elevated alkaline phosphatase. Diagnosis was confirmed on liver biopsy without evidence of cirrhosis. Her disease was complicated by pruritus that responded to treatment with rifampin 150 mg BID. She had no history of dominant strictures or cholangitis. Ulcerative colitis was diagnosed 11 years prior to presentation and had been treated with increasing doses of aminosalicylates for 5 years and subsequently transitioned to 6-mercaptopurine and later to infliximab after 7 years. She became pregnant and developed progressive arthralgias and myalgias with a positive antihistone antibody. A clinical diagnosis of infliximab-related lupus-like syndrome was made. At the time, she was in clinical remission so infliximab was discontinued, and she was treated with prednisone for the lupus-like syndrome with partial response. She continued to have mild arthralgias despite prolonged steroid taper and developed worsening cholestasis during pregnancy.