ULCERATIVE COLITIS FLARE PRESENTING AS STROKE AND THROMBOTIC STORM

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Ulcerative colitis (UC) is primarily a disease of the bowel but can exhibit extraintestinal manifestations in less than 10% patients. We report case relatively young patient with multiple thromboembolic events as rare manifestation UC. CASE PRESENTATION: A 36-year-old female history untreated UC presented expressive aphasia and syncope. She had fatigue, anorexia, intermittent diarrhea, vomiting & hematochezia last 7 months. On presentation, she fever (101.9'F), heart rate 139, blood pressure 145/81 oxygen saturation 96% on room air. Labs were remarkable for hemoglobin 3.3 g/dL, platelets 701, lactate 2.7, sodium 131, potassium 2.8, albumin 2.6, D-dimer 3.91 INR 1.3. Head CT showed focal area hypodensity left temporal lobe. Abdominal diffuse concentric mural colonic wall thickening compatible pancolitis, felt to reflect ulcerative flare. was given intravenous fluids, ceftriaxone metronidazole, subsequently transfused 3 units pRBCs. Levetiracetam seizure prophylaxis. Brain MRI 2.5-cm lobe hemorrhagic lesion post-contrast enhancement small foci diffusion restriction within peripheral frontal lobes without enhancement. TEE ejection fraction 65% no vegetations. MRV non-occlusive thromboses transverse sinus, sigmoid sinus junction right internal jugular vein. MRA unremarkable. Duplex ultrasound thrombus common femoral vein saphenofemoral junction. CTPA acute pulmonary embolism lower upper segmental arteries. Heparin drip started close monitoring ICU, her lesion. At this point, hypercoagulopathy work-up done prior anticoagulation revealed only low protein S antithrombin levels. Her neurologic exam continued improve, eventual resolution symptoms. discharged apixaban outpatient GI follow-up. DISCUSSION: IBD poses up 16-times higher risk thrombosis those Prevalence patients ~5.6%. Its pathogenesis thought be multifactorial linked excessive immune function, cytokines interleukin-6 TNF-alpha playing potential role. However, exact nature still unclear. Studies [1, 2] 25% diminished proteins C active UC, our patient. CONCLUSIONS: Our thrombi, ischemic cerebrovascular accident, severe anemia highlights potentially serious Awareness important facilitate prompt treatment. REFERENCE #1: Aadland E, et al. Free deficiency chronic inflammatory disease. Scand J Gastroenterol. 1992 Nov;27(11):957-60. doi: 10.3109/00365529209000170. PMID: 1455194 #2: Cakal B, Gokmen A, Yalinkilic M, Ayaz S, Nadir I, Ozin Y, Dagli U, Ulker A. Natural anticoagulant levels Turkish Blood Coagul Fibrinolysis. 2010 Mar;21(2):118-21. 10.1097/MBC.0b013e328335d025. 20040858 #3: Deskur Zawada Blogowski W, Starzynska T. Cerebral venous colitis: report. Medicine (Baltimore). 2019 Oct;98(41):e17428. 10.1097/MD.0000000000017428. 31593096; PMCID: PMC6799827 DISCLOSURES: No relevant relationships by Janine Beatrice Borja, source=Web Response Mohammad Khan, Taha Mohamed Djirdeh, Nagesan Rajendran,