SHM Converge Scientific Abstract ePoster Gallery-Secukinumab-Associated Fulminant Ulcerative Colitis Requiring Total Colectomy in a Patient With Refractory Hidradenitis Suppurativa

Secukinumab-Associated Fulminant Ulcerative Colitis Requiring Total Colectomy in a Patient With Refractory Hidradenitis Suppurativa

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This case report describes a 52-year-old woman with hidradenitis suppurativa whose treatment was escalated from antibiotics to secukinumab, an IL-17A inhibitor. Shortly after starting the biologic, she developed five weeks of worsening bloody diarrhea. Imaging and colonoscopy showed severe, continuous pancolitis with deep ulcerations from the rectum to the cecum, consistent with ulcerative colitis.<br /><br />Secukinumab was stopped immediately, but the patient did not improve with aggressive medical therapy, including IV steroids, mesalamine, intensified infliximab, and upadacitinib. Because of persistent hematochezia and failure of maximal treatment, she required a total abdominal colectomy with end ileostomy and rectal stump stapling.<br /><br />Her course was complicated by major postoperative morbidity, including probable small bowel obstruction, pneumoperitoneum, a suspected rectal stump leak, and a large abdominal wall fluid collection with gas. The report emphasizes that IL-17 inhibition may disrupt gut mucosal immunity and can trigger new-onset or worsened inflammatory bowel disease.<br /><br />The key message is that secukinumab, while effective for moderate to severe hidradenitis suppurativa, carries a real risk of inducing or unmasking severe colitis. Clinicians should monitor patients closely for gastrointestinal symptoms, consider baseline screening, and stop the biologic promptly if inflammatory bowel disease is suspected. The case also highlights the serious complications that can occur when fulminant colitis progresses to emergency colectomy.

Asset Subtitle

Ahmed Shah

Meta Tag

Author List Ahmed Shah, Jugraj Singh, Neychelle Rocca, Palak Gupta, Sourabh Singh

Category Clinical Vignettes

Concept Secukinumab

Concept Inflammatory Bowel Disease

Concept Ulcerative Colitis

Concept Pancolitis

Concept Drug-Induced Colitis

Distinguished Non-Finalist

Presenter Organization Midwestern University GME, Verde Valley Medical Center

Presenting Author Ahmed Shah

Track Adult

Keywords

hidradenitis suppurativa

secukinumab

interleukin-17A inhibitor

ulcerative colitis

pancolitis

bloody diarrhea

inflammatory bowel disease

colectomy

biologic therapy

colitis complications

Secukinumab

Inflammatory Bowel Disease

Ulcerative Colitis

Pancolitis

Drug-Induced Colitis