A 37-year-old patient with no toxic habits or family history of interest diagnosed with PSC in 2008 and extensive ulcerative colitis one year later.
UC during the first two years of evolution presented a mild activity, being treated with oral table.
In late 2010, there was an increase in inflammatory activity developed criteria for corticodependency and necessitating the introduction of biological treatment with infliximab with psoriasis after the same clinical and biological remission.
Concomitant to the worsening of the activity of UC, there was a rapid consolidation of the CEP, ready for orthotopic liver transplantation (OLT) due to severe hepatocellular failure and complications of portal hypertension.
The patient underwent a liver transplant from a cadaveric donor in March 2011 (starting infliximab one month before transplantation) based on immunosuppression regimen with delayed-release tacrolimus.
He presented severe cellular rejection as an immediate complication requiring complete steroid placement.
Until January 2012 (one hundred months after transplantation), ulcerative colitis had a stable course, and the patient received oral and topical treatment.
Since this date, there has been an increase in clinical and biological activity, so the biological maintenance challenge with infliximab was established according to the usual induction regimen (5 mg/kg in weeks 0, 2 and 6) and treatment.
The clinical response was not complete, predicating intensification at two months (treatment with infusion every six weeks).
In March 2012 she presented CMV infection that was successfully treated with valganvir oral.
Two months later, infliximab was switched to adalimumab sc (180:60 and 40 mg every two weeks) due to a severe infusion reaction.
The patient did not respond to adalimumab and presented a severe sprout in September 2012, when total colectomy with preservation of rectal stump and ileostomy was indicated.
One month later, ileorectal anastomosis was performed and the patient wanted to perform an exhaustive ileoanal anastomosis.
After restoration of the transit, inflammation of the refractory rectal stump was developed (total Mayo index 8, calprotectin 708 mcg/g and CRP 9.5 mg/l) with oral incapacitating diarrhea with non-responsive dose.
infusion reaction prior to infliximab and lack of previous efficacy of adalimumab was decided in January 2016 by VDZ (300 mg iv weeks 0, 2 and 6 and then every 8 weeks).
3) response without clinical interval and after 12 months of treatment was achieved clinical remission and improvement of biological parameters (decrease of calprotectin to 192 mcg/gr and normalization of CRP) as well as previous endoscopic score (MaZ).
There were no adverse events attributable to vedolizumab or interactions with tacrolimus that affected tacrolimus levels.
