Successful management of refractory ulcerative colitis with orally administered serum-derived bovine immunoglobulin therapy

This case describes a female patient with a long history of pan-colitis (>10 years) with a recent flare of disease precipitated by a Clostridium difficile infection (CDI) after experiencing septic arthritis. The CDI was successfully treated with vancomycin confirmed by a negative PCR test. The patient then experienced a flare of ulcerative colitis (UC) with 7-8 watery, bloody stools per day with cramping. Initial treatment with 30 mg oral prednisone daily and rectal mesalamine, 1 g QHS, at bedtime resulted in no change in condition. Increased oral steroid (40 mg q.d.) caused an increase of watery, bloody stools to 10-15 per day. The patient was advised to include oral serum-derived bovine immunoglobulin/protein isolate (SBI), a prescription medical food, in combination with oral steroids. Over two months, this combination effectively resolved gastrointestinal symptoms and a repeat flexible sigmoidoscopy demonstrated mucosal healing (from Mayo UC score grade 2 to grade 0). The steroid dose was tapered from 40 mg to 5 mg in combination with SBI and the patient continues to be maintained on both therapeutics for a year. We discuss the unique complications of managing this particular patient, her refusal of anti-TNF therapies and why SBI was a therapeutic option in this case. Correspondence to: Bruce P. Burnett, PhD, Entera Health, Inc., Medical Affairs, 2000 Regency Parkway, Ste. 255, Cary, NC 27518, USA, Tel: 954-299-1105, E-mail: [email protected]