A RARE PRESENTATION OF ULCERATIVE COLITIS WITH ABSCESS FORMATION

Abstract INTRODUCTION Ulcerative colitis (UC) is a chronic inflammatory condition that primarily affects the colon and is characterized by inflammation of the colon’s lining. Although uncommon, extraintestinal manifestations can occur, one of which is the formation of abscesses. This case report describes a unique situation in which a patient with UC developed multiple aseptic abscesses, which were successfully treated using a combination of corticosteroids and biological therapy. CASE PRESENTATION A 38-year-old male with a long history of ulcerative colitis presented with fever, abdominal pain, and multiple subcutaneous swellings in the sternal region. While his ulcerative colitis had been relatively controlled with mesalamine, a recent flare-up resulted in unusual extraintestinal symptoms, including abscesses. Initially, these abscesses were suspected to be bacterial in origin, but they persisted despite antibiotic therapy, and cultures returned negative for bacterial growth. Imaging studies revealed multiple aseptic abscesses in the subcutaneous tissues and liver, a rare but recognized extraintestinal manifestation of ulcerative colitis. Laboratory investigations showed elevated inflammatory markers, but no evidence of systemic infection. Given the failure of antibiotics and the patient’s history of UC, a diagnosis of aseptic abscess syndrome associated with ulcerative colitis was made. Treatment was initiated with high-dose corticosteroids, which resulted in a partial reduction in abscess size and symptom relief. To induce complete remission, infliximab, a TNF-α inhibitor, was added to the regimen. This biologic therapy led to the resolution of abscesses within weeks, and the patient’s UC symptoms also improved significantly. CONCLUSION Aseptic abscesses are a rare but serious extraintestinal complication of UC, often resistant to conventional antibiotic therapy. This case underscores the importance of considering inflammation-driven abscess formation in UC patients who present with abscesses but no signs of infection. Early identification and appropriate immunosuppressive therapy are essential to achieving remission and preventing complications. In such cases, the preferred treatment involves immunosuppressive therapy, such as corticosteroids and biologics like infliximab, which target the underlying inflammation rather than infection. Further research is necessary to comprehend the pathophysiology behind such rare manifestations and to develop optimized treatment protocols.