Ulcerative colitis severe management

Immunologic A 64-year-old woman developed persistent fever with mucositis and submandibular phlegm, not responsive to antibiotics. She was on therapy with mesalazine for ulcerative colitis, which was currently in remission, and levothyroxine for hypothyroidism. Laboratory tests showed leukopenia with severe neutropenia, and blood culture positive for multi-resistant Streptococcus oralis. The syndrome was managed with antibiotics and filgrastim. The latter drug yielded a scarce benefit, with a modest neutrophil count recovery, which was lost after its discontinuation. Mesalazine was then discontinued, and the patient had a complete and stable normalisation of her neutrophil count within the following 20 days [86 ]. 

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