{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T15:16:18Z","timestamp":1783005378072,"version":"3.54.5"},"reference-count":39,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease associated with extraintestinal manifestations, including primary sclerosing cholangitis (PSC). Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that rarely coexists with UC or PSC. The concurrent occurrence of UC, PSC, and SLE in a single individual represents a unique diagnostic and therapeutic challenge. Vedolizumab, a gut-selective biologic agent, is effective for managing UC; however, its utility in patients presenting with this triad of conditions has not yet been explored. Case summary: A 32-year-old man presented with a 10-year history of recurrent upper abdominal pain, frequently accompanied by high-grade fever, along with recent onset of jaundice, diarrhea, hematochezia, and chronic rashes. Diagnostic evaluation confirmed PSC, SLE, and severe UC. During hospitalization, the patient also developed bacteremia. Initial management of UC with mesalazine and immunosuppressants (azathioprine followed by cyclosporine) resulted in limited clinical improvement. Vedolizumab was subsequently initiated, resulting in marked clinical improvements and near-complete endoscopic remission of UC. PSC and SLE remained clinically stable with ongoing therapies; however, the patient is currently awaiting liver transplantation for PSC. Conclusions: This case highlights the potential utility of vedolizumab in the treatment of UC in patients with concurrent PSC and SLE.<\/jats:p>","DOI":"10.3390\/jcm15135166","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T14:43:14Z","timestamp":1783003394000},"page":"5166","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rescue Vedolizumab Therapy for a Rare Case of Complicated Severe Ulcerative Colitis: A Case Report and Literature Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Shih-Tsung","family":"Fu","sequence":"first","affiliation":[{"name":"Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan"},{"name":"School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Po","family":"Chang","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan"},{"name":"Department of Pathology, China Medical University Hospital, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Jhe","family":"Hong","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan"},{"name":"Division of Rheumatology and Immunology, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jen-Wei","family":"Chou","sequence":"additional","affiliation":[{"name":"Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4946-1257","authenticated-orcid":false,"given":"Yi-Hua","family":"Wu","sequence":"additional","affiliation":[{"name":"Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan"},{"name":"School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.cgh.2017.06.016","article-title":"Natural history of adult ulcerative colitis in population-based cohorts: A systematic review","volume":"16","author":"Fumery","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.bpg.2010.07.005","article-title":"Primary sclerosing cholangitis","volume":"24","author":"Karlsen","year":"2010","journal-title":"Best Pract. Res. Clin. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101272","DOI":"10.1016\/j.jhepr.2024.101272","article-title":"Primary sclerosing cholangitis\u2013inflammatory bowel disease: Epidemiology, mortality, and impact of diagnostic sequence","volume":"7","author":"Leung","year":"2025","journal-title":"JHEP Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S289","DOI":"10.14309\/00000434-201610001-00629","article-title":"Ulcerative colitis with PSC has higher mortality, higher healthcare utilization, and worse clinical outcomes compared to UC only patients: National inpatient sample","volume":"111","author":"Bhardwaj","year":"2016","journal-title":"Am. J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1093\/rheumatology\/38.10.917","article-title":"A review of gastrointestinal manifestations of systemic lupus erythematosus","volume":"38","author":"Sultan","year":"1999","journal-title":"Rheumatology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1177\/0961203310374337","article-title":"Major gastrointestinal manifestations in lupus patients in Asia: Lupus enteritis, intestinal pseudo-obstruction, and protein-losing gastroenteropathy","volume":"19","author":"Chng","year":"2010","journal-title":"Lupus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1191\/0961203303lu433oa","article-title":"Reversible acute gastrointestinal syndrome associated with active systemic lupus erythematosus in patients admitted to hospital","volume":"12","author":"Lian","year":"2003","journal-title":"Lupus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1177\/0961203307082383","article-title":"Lupus enteritis: Clinical characteristics, risk factor for relapse, and association with anti-endothelial cell antibody","volume":"16","author":"Kwok","year":"2007","journal-title":"Lupus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1097\/01.meg.0000214624.45308.81","article-title":"Sequential manifestation of autoimmune diseases: An unusual case","volume":"18","author":"Mattiuzzo","year":"2006","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/j.1365-2133.1994.tb02938.x","article-title":"Systemic lupus erythematosus in association with ulcerative colitis: Related autoimmune diseases","volume":"130","author":"Stevens","year":"1994","journal-title":"Br. J. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/S0140-6736(88)91581-4","article-title":"Systemic lupus erythematosus and ulcerative colitis","volume":"331","author":"Font","year":"1988","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"21060","DOI":"10.1038\/s41598-022-25218-x","article-title":"The long-term effect of biologics in patients with ulcerative colitis emerging from a large Japanese cohort","volume":"12","author":"Yokoyama","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1056\/NEJMoa1215734","article-title":"Vedolizumab as induction and maintenance therapy for ulcerative colitis","volume":"369","author":"Feagan","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_14","first-page":"1177","article-title":"CD19 CAR T-Cell Therapy in Multidrug-Resistant Ulcerative Colitis","volume":"393","author":"Atreya","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"196","DOI":"10.2169\/internalmedicine.5491-25","article-title":"Recent Advances in Molecular Targeted Therapy for Inflammatory Bowel Disease","volume":"65","author":"Hisamatsu","year":"2025","journal-title":"Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.surge.2018.04.001","article-title":"A systematic review of the aetiology and management of post cholecystectomy syndrome","volume":"17","author":"Isherwood","year":"2019","journal-title":"Surgeon"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1155\/1991\/57017","article-title":"Reoperation after cholecystectomy. The role of the cystic duct stump","volume":"4","author":"Rogy","year":"1991","journal-title":"HPB Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3390\/tomography10010005","article-title":"Primary sclerosing cholangitis: Diagnostic criteria","volume":"10","author":"Cazzagon","year":"2024","journal-title":"Tomography"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1002\/art.40930","article-title":"2019 European League Against Rheumatism\/American College of Rheumatology classification criteria for systemic lupus erythematosus","volume":"71","author":"Aringer","year":"2019","journal-title":"Arthrit. Rheumatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1016\/S0140-6736(16)32126-2","article-title":"Ulcerative colitis","volume":"389","author":"Ungaro","year":"2017","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1093\/rheumatology\/kead689","article-title":"Lupus enteritis: A narrative review","volume":"63","author":"Sangle","year":"2024","journal-title":"Rheumatology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1038\/s12276-023-01042-9","article-title":"Primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD): A condition exemplifying the crosstalk of the gut\u2013liver axis","volume":"55","author":"Kim","year":"2023","journal-title":"Exp. Mol. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1186\/s40001-024-01941-1","article-title":"Causal relationship between primary sclerosing cholangitis and systemic lupus erythematosus: A bidirectional Mendelian randomization study","volume":"29","author":"Pan","year":"2024","journal-title":"Eur. J. Med. Res."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Yuan, W., Luo, Q., and Wu, N. (2024). Investigating the shared genetic basis of inflammatory bowel disease and systemic lupus erythematosus using genetic overlap analysis. BMC Genom., 25.","DOI":"10.1186\/s12864-024-10787-0"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sun, H.-W., Zhang, X., and Shen, C.-C. (2024). The shared circulating diagnostic biomarkers and molecular mechanisms of systemic lupus erythematosus and inflammatory bowel disease. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1354348"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.cgh.2020.10.003","article-title":"Comparative safety and effectiveness of vedolizumab to tumor necrosis factor antagonist therapy for ulcerative colitis","volume":"20","author":"Lukin","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1136\/gutjnl-2015-311079","article-title":"The safety of vedolizumab for ulcerative colitis and Crohn\u2019s disease","volume":"66","author":"Colombel","year":"2017","journal-title":"Gut"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/j.cgh.2022.07.032","article-title":"Comparative risk of serious infections with biologic agents and oral small molecules in inflammatory bowel diseases: A systematic review and meta-analysis","volume":"21","author":"Solitano","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/apt.14075","article-title":"Systematic review: The safety of vedolizumab for the treatment of inflammatory bowel disease","volume":"46","author":"Bye","year":"2017","journal-title":"Aliment Pharmacol. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1097\/MCG.0000000000001733","article-title":"Risk of gastrointestinal infections after initiating vedolizumab and anti-TNF\u03b1 agents for ulcerative colitis","volume":"57","author":"Dalal","year":"2023","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.cgh.2019.05.013","article-title":"Effects of vedolizumab in patients with primary sclerosing cholangitis and inflammatory bowel diseases","volume":"18","author":"Lynch","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1111\/apt.14525","article-title":"Vedolizumab in patients with concurrent primary sclerosing cholangitis and inflammatory bowel disease does not improve liver biochemistry but is safe and effective for bowel disease","volume":"47","author":"Christensen","year":"2018","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_33","unstructured":"(2026, June 28). U.S. Food and Drug Administration, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2022\/125476Orig1s046lbl.pdf."},{"key":"ref_34","first-page":"277","article-title":"Chronic cholestatic liver injury attributable to vedolizumab","volume":"4","author":"Stine","year":"2016","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Yeh, H., Wu, R.-C., Tsai, W.-S., Kuo, C.-J., Su, M.-Y., Chiu, C.-T., and Le, P.-H. (2021). Systemic lupus erythematosus complicated by Crohn\u2019s disease with rectovaginal fistula. BMC Gastroenterol., 21.","DOI":"10.1186\/s12876-021-01801-w"},{"key":"ref_36","first-page":"S10","article-title":"P-016. Vedolizumab and drug-induced lupus: An unexpected phenomenon","volume":"23","author":"Johnston","year":"2017","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.14309\/crj.0000000000001270","article-title":"Recurrence of drug-induced lupus secondary to vedolizumab use in a patient with Crohn\u2019s disease","volume":"11","author":"Rodriguez","year":"2024","journal-title":"ACG Case Rep. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e47","DOI":"10.1093\/ibd\/izaa331","article-title":"Drug-induced Lupus associated with vedolizumab in a patient with Crohn\u2019s disease","volume":"27","author":"Sedano","year":"2021","journal-title":"Inflamm. Bowel. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.autrev.2018.03.016","article-title":"Drug-induced lupus: Traditional and new concepts","volume":"17","author":"Vaglio","year":"2018","journal-title":"Autoimmun. Rev."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5166\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T14:46:17Z","timestamp":1783003577000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5166"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":39,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15135166"],"URL":"https:\/\/doi.org\/10.3390\/jcm15135166","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]}}}