He is given infliximab on day 3, given high risk of steroid failure by Travis and Ho indices. Despite daily IV methylprednisolone and one dose of infliximab, he notes no change in his symptoms by day 7 of the hospitalization.
What do you recommend next?
Tofacitinib 10 mg bid
Cyclosporine with bridge to vedolizumab
Addition of azathioprine
Colorectal surgery consult
Continue IV steroids until next infliximab infusion at 2 week mark
The patient consults with colorectal surgery and opts to proceed with first part of a 3-part laparoscopic total colectomy with eventual ileal pouch anal anastomosis. Post-operatively, he completes a rapid steroid taper. Months later, he successfully completes take-down surgery without complication.
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