Background: A 32-year-old white Jewish woman was referred to our clinic in October 2002 for a second opinion on the management of her active extensive ulcerative colitis that did not respond to oral mesalazine (mesalamine) 3.6 g/day. The severity of symptoms had affected her plans to have children.
Investigations: Laboratory investigations, including perinuclear antineutrophil cytoplasmic antibodies and antibodies to Saccharomyces cerevisiae, stool cultures, and sigmoidoscopy to 40 cm from the rectum, with biopsies.
Diagnosis: Moderate-to-severe active extensive ulcerative colitis, unresponsive to mesalazine at 3.6 g/day.
Management: Oral mesalazine 4.8 g/day and 4 g mesalazine enemas nightly.