S133 Disparities in Clinical Outcomes Between Younger and Older UC Patients With Respect to Insurance Status: An Analysis of the National Inpatient Sample 2016-2020

Abstract

Background: Parenteral glucocorticoids are a well-established treatment for acute severe ulcerative colitis(ASUC) fl aresin hospitalizedpatients. Mostreportsymptomaticimprovementwithin3-5days of startingtreatment. However,forthose withno improvementafter 5 days,considerationof second-line agents, such as in fl iximab or cyclosporine, is warranted. We report a case of ASUC and con-comitantCMV infectionrefractorytosystemicsteroidsand ganciclovir,requiringaddition ofa TNF-alpha inhibitor. Methods: A 40-year-old female with a history of iron-de fi ciency anemia presented with a 1-month history of abdominal pain and hematochezia. Prior fl exible sigmoidoscopy showed moderate in-fl ammation from 25cm to the anal verge, and biopsies were consistent with UC. She was discharged with a 20mg prednisone taper and PO mesalamine. Despite therapy, patient had worsening hema-tochezia, frequent nocturnal stooling, arthralgias, and weight loss, prompting return to the hospital. On admission, fecal calprotectin was elevated, 248 mcg/g. She was started on IV Solumedrol, 20mg every 8 hours. Results: After 3 days of treatment, her pain and hematochezia were persistent. GI PCR and C. di ff testing were negative, and she required blood transfusion for symptomatic anemia. Repeat colonoscopy to the transverse colon showed Mayo 3 left-sided colitis, and biopsies were consistent with UC with moderate in fl ammatory activity. Biopsied tissue was PCR-positive for CMV infection. Patient was started on IV ganciclovir, 5mg/kg twice daily. Following 3 days of treatment for CMV, symptoms had not improved. After discussing risks/bene fi ts between consulting services, in fl iximab 10mg/kg was started with signi fi cant symptom improvement the following day, with stool frequency decreased to 3-4 daily from 10 1 . She was discharged on a 40mg