ZyraDoc #02 - August 04, 2026

A 28-year-old woman presents with acute severe ulcerative colitis passing 8-10 bloody stools daily with severe abdominal cramping.

She is admitted to the hospital and started on high-dose IV methylprednisolone (60 mg/day).

By hospital day 3, her frequent bloody diarrhea, abdominal tenderness, and elevated C-reactive protein (CRP) show no improvement.

Case Summary

Clinical Focus:

A 28-year-old female with acute severe ulcerative colitis (ASUC) remains refractory to 3 days of high-dose IV corticosteroid therapy, requiring urgent second-line medical rescue or surgical intervention.

Diagnostic criteria for Acute Severe Ulcerative Colitis (Truelove and Witts criteria) include:

≥ 6 bloody stools per day
Fever (temperature > 37.8°C) or tachycardia (heart rate > 90 bpm)
Anemia (hemoglobin < 10.5 g/dL) or elevated inflammatory markers (ESR > 30 mm/h or CRP > 45 mg/L)

When high-dose IV steroids fail to produce a clinical response by day 3 to 5, deciding between medical rescue therapy (Infliximab vs Cyclosporine) and emergency total colectomy is one of the most critical and highly debated decisions in gastroenterology.

Here is the Management Strategy:

You've already played this ZyraDoc! Try out others from the Archives, or come back tomorrow for a new one!

Incorrect!

Correct!

Please pick from the selection list or skip

1/3.

✗

2/3.

✗

3/3.

✗

What's the Best Next Step?

Case Summary

Reset Password

Verify Your Account

Verify Your Account