A 30-year-old man with established ulcerative colitis presents with bloody diarrhea 8 times per day, temperature 38.6 degrees C, pulse 112/min, hemoglobin 9.4 g/dL, and ESR 42 mm/hr. Abdominal radiograph shows no colonic dilatation. Which classification best describes this presentation?
- A Moderate UC flare
- B Toxic megacolon
- C Acute severe ulcerative colitis ✓
- D Fulminant Crohn colitis
Correct answer: C. Acute severe ulcerative colitis
Explanation
Truelove and Witts criteria define acute severe UC as six or more bloody stools per day plus at least one systemic feature: fever above 37.8 degrees B, pulse above 90/min, hemoglobin below 10.5 g/dL, or ESR above 30 mm/hr. This patient meets all criteria. Toxic megacolon requires radiographic colonic dilatation greater than 6 cm with systemic toxicity, which is absent here. Fulminant colitis is distinguished by toxicity with more than ten stools daily.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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