Case 2

A 54-year-old woman with 20 year history of panulcerative colitis and recent deep vein thrombosis (DVT) treated with 6 months of enoxaparin presents to the hospital with one month of bloody diarrhea and abdominal pain. Prior therapy includes mesalamine and budesonide enemas.

One year ago, she was hospitalized with a UC flare and DVT. She was started on infliximab with initial symptomatic improvement. However, symptoms returned, and she was found to have undetectable infliximab serum trough levels and detectable antidrug antibodies. She was switched to vedolizumab with only partial improvement in symptoms and endoscopic evidence of ongoing inflammation.

Her current treatment is ustekinumab 90 mg every 8 weeks. She has required numerous steroid courses over the last 20 years and has evidence of weight gain and moon facies. Flexible sigmoidoscopy performed within the first 24 hours of admission shows the following in the sigmoid colon

Using the Mayo Endoscopic Score, how would you rate her disease severity
Mayo 0
Mayo 0 Disease is characterized as “Normal or inactive disease”. These images are more severe than this.
Mayo 1
Mayo 1 is characterized as “Mild disease with erythema, decreased vascular pattern, and mild friability”. These images are more severe than this.
Mayo 3
Mayo 3 disease is characterized as “severe disease with spontaneous bleeding and deep ulceration”. This image shows the deep ulcerations characteristic of mayo 3 disease.
Mayo 2
Mayo 2 disease is characterized by “moderate disease with marked erythema, absent vascular pattern, friability, and erosions”. While there is noted erythema and absent vascular markings, the ulcerations noted in this image are more consistent with Mayo 3 disease.

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