A review of the literature on three extraintestinal complications of ulcerative colitis : an ulcerative colitis flare complicated by Budd-Chiari syndrome, cerebral venous thrombosis and idiopathic thrombocytopenia

Extraintestinal manifestations are well described and recognized in association with ulcerative colitis. Immunologically mediated and thrombotic events are among the more rare manifestations associated with flares. These manifestations include Budd-Chiari syndrome, idiopathic thrombocytopenia, and cerebral venous thrombosis. A 22 year-old male with a three-year history of ulcerative colitis presented with worsening hematochezia, fatigue, headache and upper respiratory symptoms. Laboratory evaluation demonstrated a platelet count of 24 x 10(9)/L (normal baseline platelet count noted 3 months prior) and hemoglobin of 8.6 x 10(9)/L. Imaging demonstrated hepatic venous thrombosis consistent with Budd-Chiari syndrome and cerebral venous thrombosis. Based on peripheral smear analysis and eventual marked response to steroids, a diagnosis of idiopathic thrombocytopenia was made. He was started on prednisone 40mg daily with brisk improvement in both his ulcerative colitis flare and his platelet count increasing above 100 x 10(9)/L. He was therapeutically anticoagulated for the cerebral venous thrombosis. He continued to do well and was discharged on therapeutic enoxaparin and a 40 mg prednisone taper without recurrent flare or idiopathic thrombocytopenia two weeks post-hospitalization. To our knowledge, this is the first report of all three known but rare complications diagnosed concurrently in the same patient. This review examines three extraintestinal complications of ulcerative colitis, including the presentation, diagnosis, and treatment.