An 18-year-old man with a 13 month history of ulcerative coltis (UC) was admitted with a progressive history of worsening left-sided abdominal pain, diarrhoea, rectal bleeding and weight loss. UC had been diagnosed on flexible sigmiodoscopy and biopsies, which confirmed moderately active colitis to the point of insertion (distal descending colon). Initially he was commenced on mesalazine and steroids, but his disease remained active and azathioprine was introduced after 4 months. Despite this he continued to suffer active symptoms, and a colonoscopy was performed after 8 months. This demonstrated some improvement, with mildly active colitis evident to the sigmoid. The full extent of his colitis was not established as the procedure was limited to the sigmoid because of patient discomfort. Over the next 4 months his condition and blood tests gradually worsened to the point that he required admission.
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