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Acute severe ulcerative colitis — ABIM Board MCQ

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ModerateGastroenterology/HepatologyAcute severe ulcerative colitisABIM Board

A 28-year-old man with ulcerative colitis has 10 bloody stools daily, fever, pulse 112/min, and hemoglobin 9.8 g/dL. Abdominal radiograph shows colonic diameter 5.2 cm without perforation. Stool testing for C. difficile is negative. Which of the following is the most likely diagnosis?

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Correct answer: C — Acute severe ulcerative colitis

Frequent bloody stools with systemic toxicity and anemia in a patient with ulcerative colitis meets criteria for acute severe ulcerative colitis. Colonic dilation is below typical toxic megacolon thresholds and no perforation is present.

Reference: ACG Ulcerative Colitis Guideline; AGA IBD Guidance