Use of Novel Oral Anticoagulant to Treat Pulmonary Thromboembolism in Patient with Ulcerative Colitis Superinfected Cytomegalovirus Colitis

Seok-Hwan Kim; Sunhee Jang; Yegyu Sung; Jun Kyu Park; Yunjung Park; Jintak Yun; Sang-Bum Kang

doi:10.4166/kjg.2017.70.1.44

Journal List > Korean J Gastroenterol > v.70(1) > 1007725

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Kim, Jang, Sung, Park, Park, Yun, and Kang: Use of Novel Oral Anticoagulant to Treat Pulmonary Thromboembolism in Patient with Ulcerative Colitis Superinfected Cytomegalovirus Colitis

Case Report

Korean J Gastroenterol 2017;70(1):44-49.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.70.1.44

Use of Novel Oral Anticoagulant to Treat Pulmonary Thromboembolism in Patient with Ulcerative Colitis Superinfected Cytomegalovirus Colitis

Seok-Hwan Kim, Sunhee Jang¹, Yegyu Sung¹, Jun Kyu Park¹, Yunjung Park¹, Jintak Yun, Sang-Bum Kang

Division of Gastroenterology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea

¹Department of Internal Medicine, Catholic Medical Center, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Sang-Bum Kang, Division of Gastroenterology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon 34943, Korea. Tel: +82-42-220-9501, Fax: +82-42-252-6807, E-mail: dxandtx@catholic.ac.kr

Received 26 April 2017 Revised 3 July 2017 Accepted 11 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Crohn's disease and ulcerative colitis are the two major types of inflammatory bowel disease, and affect mainly the gastrointestinal tract but also have extraintestinal sequelae, such as arterial and venous thromboembolism. Thromboembolic complications, particularly pulmonary thromboembolism, can be life threatening and require prompt management with anticoagulants. Conventional vitamin K antagonists have been used for the treatment of thromboembolic complications, but the development of novel oral anti-coagulants has shifted the paradigm. We report a case of a 42-year-old female with ulcerative colitis who experienced an acute flare-up due to cytomegalovirus superinfection with pulmonary thromboembolism. She was treated with oral mesalamine, intravenous steroid and ganciclovir and low-molecular-weight heparin, followed by rivaroxaban, a novel oral anticoagulant. Her symptoms resolved after treatment, and no recurrence was noted during a 6-month post-treatment follow-up.

Keywords: Inflammatory bowel disease, Ulcerative colitis, Pulmonary thromboembolism, Rivaroxaban, Cytomegalovirus

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Fig. 1.

Multiple longitudinal and geographic ulcerations with some denuded colonic mucosa and easy touch bleeding were noted from the distal descending colon to the rectum. CMV PCR of the tissue biopsy confirmed CMV colitis. (A) Descending colon. (B) Proximal sigmoid colon. (C) Distal sigmoid colon. (D) Rectum. CMV, cytomegalovirus; PCR, polymerase chain reaction.

Fig. 2.

Chest dynamic computed tomography showed a filling defect in the lobar and segmental branches of the right pulmonary artery (arrows). (A, B) Transverse view. (C, D) Coronal view.

Fig. 3.

Lower extremity computed tomography showed diffuse filling defect from the left common iliac vein to the calf veins of the lower left leg (arrows), and normal vessels of the lower right leg (arrowhead). (A) Iliac crest level. (B) Symphysis pubis level. (C) Popliteal level.

Fig. 4.

Follow up chest computed tomography after 2 months of rivaroxaban treatment. The previously noted filling defect in the lobar and segmental branches of the right pulmonary artery had disappeared. (A, B) Transverse view. (C, D) Coronal view.

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