The pediatrician and steroid resistance in ulcerative colitis

Despite the availability of new immunomodulators, steroids still represent a milestone of Inflammatory Bowed Disease (IBD) therapy. Steroid resistance in IBD is an uncommon, yet existing and epidemiologically defined event involving one fifth of the patients with Crohn's disease and one sixth of the patients with ulcerative colitis (UC). We report of an 11 year old female patient with previously diagnosed UC that was hospitalized during a flare of the disease and that failed to respond to a four week intravenous and oral administration of steroids (2 mg/kg). The radioligand binding of the steroid receptors showed that a significantly higher dose of metilprednisolone was necessary to inhibit the growth of 50% of the lymphocytes (EC50) in our patient, if compared to the values obtained on 11 healthy controls (2,326 μM and 1,056 ± 53.14 μM respectively). Infliximab was administered and successfully induced. The epidemiology of steroid resistance and possible therapeutic approaches in steroid resistant patients are discussed.