Low-dose intravenous azathioprine may be effective in the management of acute fulminant colitis complicating inflammatory bowel disease

Background: The management of acute fulminant colitis unresponsive to intra venous steroids is usually surgical, However, recent evidence suggests that intravenous administration of azathioprine at very high doses may allow mo re rapid onset of clinical efficacy, although its use has not previously be en reported in the emergency situation. Aim: To report the successful use of intravenous azathioprine in the manage ment of acute fulminant colitis complicating both Crohn's disease and ulcer ative colitis, Method: We initially used intravenous azathioprine because of the refusal o f the family of the first patient to accept surgery following failure of co nventional medical management. Importantly the azathioprine was successful at the low dose of 3 mg/kg,day, equivalent to standard oral doses, Two subs equent patients demonstrated a similar resolution. All were weaned successf ully to oral azathioprine and have remained in long-term endoscopic and his tological remission. Conclusion: These preliminary data suggest that low-dose intravenous azathi oprine may be helpful adjunct therapy in selected cases of severe fulminant colitis, However, the need for close monitoring and daily surgical assessm ent remains paramount, and a formal trial of low-dose intravenous azathiopr ine is required before it may be more widely recommended.