We report the case of a 35-year-old woman with no toxic habits or family history of interest with a diagnosis of PSC in 2010.
After diagnosis the existence of association with UC was studied by means of complete lower endoscopy without macroscopic or histological alterations.
In 2013, she underwent cadaveric liver transplantation for hepatocellular failure and recurrent cholangitis.
There were no immediate post-transplant complications, with good graft function and immunosuppression regimen based on extended-release tacrolimus.
Nine months after transplantation, the patient developed bleeding diarrhea, with a diagnosis of UC of extensive location and moderate clinical and endoscopic activity.
Since the first months of UC diagnosis, the patient met criteria for corticoid dependence.
After monthly maintenance of mild leukopenia, azathioprine was not chosen and biological anti-TNFα treatment was decided with subcutaneous golimumab (usual induction dose 200 mg sc initially, 100 mg weight at two weeks).
The response to golimumab was only partial, requiring intensification at 100 mg from the second treatment and not with a monthly anti-TNF agent discontinuation to oral steroids by infliximab at 4 months of treatment golimumab.
After initiating IFX at conventional induction doses (5 mg/kg intravenous [iv], weeks 0, 2 and 6), neither clinical response nor steroid withdrawal was achieved after six months of treatment, despite early intensification of four weeks intravenous infusion (5 mg/kg).
Monitoring blood levels of IFX showed they were in therapeutic range.
This, together with the absence of anti-oximeb antibodies and concomitant infection or cytomegalovirus (CMV) superinfection, changed the therapeutic target.
In December 2016 (35 months after transplantation), it was decided to start treatment with vedolizumab (VDZ), according to usual induction regimen (300 mg iv at weeks 0, 2 and 6), and maintenance with 300 mg IV VDZ every eight weeks.
Just before starting VDZ, the patient had a total Mayo index of 7.
After the second infusion, a clinical response was observed with normalization of the depositional habit, but maintaining high biological activity parameters (fecal calcium 805 mcg/g and C-reactive protein [CRP] 8 mg/l).
After three months of treatment, steroids were discontinued, and one month after their withdrawal, intensified treatment with VDZ was required, achieving a four-week infusion interval.
After one year of treatment her total Mayo score was 4 (endoscopic subscore 1), calprotectin decreased to 270 mcg/g and CRP levels returned to normal.
Tacrolimus levels remained stable within the target range (5-10 ng/ml) and did not require dose adjustments.
Liver biochemistry has remained stable throughout this period.
To date, no infectious adverse effects or drug interactions have been reported.
