ASSOCIATED ULCERATIVE-COLITIS, SCLEROSING CHOLANGITIS, AND INSULIN-DEPENDENT DIABETES-MELLITUS

We report two young men with clinical and laboratory evidence of macro scopic utcerative colitis, sclerosing cholangitis, and insulin-depende nt diabetes mellitus. The first patient presented at age 15 with vomit ing, abdominal pain, weight loss, and abnormal liver function test res ults. Liver biopsy and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated sclerosing cholangitis. Colonoscopy with biopsy re vealed ulcerative colitis which responded to sulfasalazine. Diabetes o ccurred at age 18 and insulin therapy was begun. The second patient wa s 19 at presentation with diarrhea, hematochezia, and weight loss. Pro ctosigmoidoscopy revealed ulcerative colitis, and sulfasalazine led to clinical remission. Three months later he developed diabetes requirin g insulin therapy. At age 28, he developed elevated alkaline phosphata se, and ERCP revealed sclerosing cholangitis. At age 37 he expired fro m adenocarcinoma that metastasized to the liver. Literature review rev ealed only one possible case report of this association with microscop ic asymptomatic ulcerative colitis in that patient. Statistical analys is suggests that this association is real rather than a chance occurre nce. An autoimmune process may be involved and a specific histocompati bility locus antigen (HLA) type may exert a regulatory influence.