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 22year-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 × 109/L (normal baseline plate- let count noted 3 months prior) and hemoglobin of 8.6 × 109/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 × 109/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 concur- rently-in-the-same-patient.-This-review-examines-three-extraintesti- nal complications of ulcerative colitis, including the presentation, diagnosis, and treatment. (Acta gastroenterol. belg., 2013, 76, 311- 316).