A 25-year-old woman presents with watery diarrhea 10–15 times per day, urgency, and bloody stool. Colonoscopy shows continuous mucosal inflammation from rectum to splenic flexure with loss of haustrations. Biopsy shows crypt abscesses and distorted crypt architecture without granulomas. The diagnosis is ulcerative colitis. For induction of remission in moderate-to-severe UC, the treatment of choice is:

• A Oral mesalazine 4.8 g/day alone
• B Infliximab alone without steroids
• C Cyclosporine 4 mg/kg/day
• D IV methylprednisolone 60 mg/day ✓

Explanation

Moderate-to-severe UC (Truelove-Witts criteria or Mayo score ≥6) that fails oral 5-ASA requires hospital admission and IV corticosteroids (methylprednisolone 40–60 mg/day or hydrocortisone 400 mg/day). Response should be assessed at 72 hours; non-responders are considered for rescue therapy with infliximab or ciclosporin. Oral mesalazine is suitable for mild-to-moderate disease only. Infliximab may be used as first-line rescue for steroid-refractory disease.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.