Extensive venous thrombosis – A rare presentation of ulcerative colitis in a young female

Abstract

Extraintestinal manifestations (EMs) are well recognised in association with ulcerative colitis (UC). Immunologically mediated and thrombotic events are uncommon manifestations of this disease. We present the case of a 28-year-old female with a 2-year history of loose stools presenting with bilateral lower limb oedema. On evaluation, extensive deep venous thrombosis of bilateral lower limbs extending to the inferior vena cava and acute on chronic pulmonary thromboembolism was evident. Laboratory evaluation demonstrated anaemia, leucocytosis, elevated C-reactive protein and erythrocyte sedimentation rate, positive perinuclear antinuclear cytoplasmic antibody, antinuclear antibody-immunofluorescence and stool for occult blood. Colonoscopy and histopathological examination of colonic mucosa were suggestive of inflammatory bowel disease favouring the diagnosis of UC. She was started on oral prednisolone 20 mg daily with brisk improvement in her anaemia. She was therapeutically anticoagulated for extensive venous thrombosis. She continued to deteriorate and developed severe respiratory distress and cardiogenic shock and was given mechanical ventilatory support. This case report reviews venous thrombosis as a rare extraintestinal complication of UC, including the presentation, diagnosis and treatment.