SHM Converge Scientific Abstract ePoster Gallery-Aseptic Abscesses as a Rare Complication in Ulcerative Colitis

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A 39-year-old woman with untreated ulcerative colitis presented with two weeks of abdominal pain, hematochezia, weight loss, and night sweats. She was tachycardic, had diffuse abdominal tenderness, and marked leukocytosis, so an ulcerative colitis flare was initially suspected and IV methylprednisolone was started. CT imaging then revealed abscesses in the liver, spleen, and pancreas, raising concern for disseminated infection or malignancy. Steroids were stopped and broad-spectrum antibiotics begun.<br /><br />Despite antimicrobial escalation, she developed fevers, vomiting, worsening leukocytosis, and continued bloody stools. MRI showed that the abscesses had decreased in size, but her clinical status remained poor. Colonoscopy ruled out malignancy, and infectious evaluation was negative, including sterile cultures. Because the pattern fit aseptic abscess syndrome, a rare extraintestinal manifestation of inflammatory bowel disease, corticosteroids were restarted.<br /><br />After steroid reinitiation, she improved clinically with reduced hematochezia and overall symptom relief. Follow-up CT two months later showed resolution of the liver and pancreatic abscesses and further decrease in the splenic abscess.<br /><br />This case highlights aseptic abscesses as an uncommon but important complication of inflammatory bowel disease, including ulcerative colitis. These lesions are sterile, often mimic infection, and typically do not improve with antibiotics but respond to corticosteroids. There are no established treatment guidelines, but steroids appear to be the most effective therapy. Recognizing this entity is critical to avoid unnecessary antimicrobial exposure, invasive procedures, and delays in treating the underlying UC flare.

Asset Subtitle

Chelsea S. Wu

Meta Tag

Author List Chelsea S. Wu, Kanapa Kornsawad, Sydney Tran

Category Clinical Vignettes

Concept Aseptic Abscess Syndrome

Concept Ulcerative Colitis

Concept Sterile Abscess

Concept Extra-Intestinal Manifestation

Concept Inflammatory Bowel Disease

Distinguished Non-Finalist

Presenter Organization University of Texas Health Sciences Center San Antonio Long School of Medicine

Presenting Author Chelsea S. Wu

Track Adult

Keywords

ulcerative colitis

aseptic abscess syndrome

inflammatory bowel disease

liver abscess

splenic abscess

pancreatic abscess

corticosteroids

hematochezia

sterile cultures

extraintestinal manifestation

Aseptic Abscess Syndrome

Ulcerative Colitis

Sterile Abscess

Extra-Intestinal Manifestation

Inflammatory Bowel Disease