A comorbidity of ulcerative colitis, ankylosing spondylitis, Takayasu's arteritis and silent thyroiditis: an extensive case-based review

Abstract

Introduction and importance: Ulcerative colitis is a chronic condition characterized by continuous inflammation of the rectum and colon. Its clinical complications extend beyond the gastrointestinal tract to involve multiple systems, including musculoskeletal, hepatobiliary, cardiovascular, and ocular manifestations. Takayasu arteritis and ankylosing spondylitis are two autoimmune inflammatory disorders that have previously been reported as coexisting conditions associated with ulcerative colitis. is an autoimmune-mediated inflammation of the thyroid gland causing the release of thyroid hormones and is considered a variant form of chronic autoimmune thyroiditis (Hashimoto's thyroiditis).

Case presentation: The authors report a case of a 32-year-old Caucasian man with a 3-year history of ulcerative colitis who presented to our clinic in 2015, complaining of chronic lower back pain that alleviates with exercise but does not relieve with rest. Based on our physical exam findings and lab results, ankylosing spondylitis was diagnosed using Assessment of Spondylarthritis International Society and New York criteria. Computerized tomography angiography was performed and demonstrated stenosis in multiple arteries. These findings satisfied the American College of Rheumatology criteria for Takayasu's disease. After the Infliximab was started, the patient had significant symptomatic improvement.

Clinical discussion: The use of biological therapy plays a key role in the treatment of many autoimmune illnesses. The patient was considered resistant and nonresponsive to treatment; thus, biological therapy was indicated, and infliximab was administered, resulting in a significant clinical improvement and remission of all illnesses.

Conclusion: The authors aim to report a rare coexistence of ulcerative colitis, ankylosing spondylitis, Takayasu's arteritis and silent thyroiditis. And the authors believe this can aid in diagnosing and management of rare diseases.

Keywords: Takayasu arteritis; ankylosing spondylitis; infliximab; silent thyroiditis; ulcerative colitis.

Figure 1

Spinal X-ray demonstrated bilateral grade II sacroiliitis and loss of lumbar lordosis (A, B).

Figure 2

Computed tomography angiography demonstrating stenosis in the left common carotid artery, left vertebral artery, right subclavian artery, and occlusion of the left subclavian artery (A, B).

Figure 3

Colonoscopy revealing edematous, erythematous, friable mucosa with surface ulcerations extending from the rectum to the splenic flexure of the colon (A, B).

Figure 4

Brain computed tomography scan showing low-density areas located in both cerebellar hemispheres, indicative of cerebellar infarction.

Figure 5

Ultrasonography and 99mTC pertechnetate thyroid scintigraphy.

Figure 6

Pelvic X-ray showed bilateral grade IV sacroiliitis.