S4942 A Case of Sulfasalazine-Induced Pancreatitis and Incomplete Steroid Taper in a Patient With Ulcerative Colitis: Diagnostic and Therapeutic Challenges

Introduction: Ulcerative colitis (UC) is a chronic inflammatory condition of the colon with variable severity and extraintestinal manifestations. Complications may arise due to medication side effects or incomplete adherence to therapy. Sulfasalazine-induced pancreatitis is rare but clinically significant. We present a case of a UC patient with suspected medication-induced pancreatitis and poorly controlled disease due to premature steroid discontinuation. Case Description/Methods: Thirty-seven-year-old woman with a 5-year history of UC, initially treated with mesalamine and later transitioned to sulfasalazine. She presented with worsening abdominal pain and bloody stools. In December 2024, she was hospitalized with acute interstitial pancreatitis and a concurrent UC flare. Computed tomography imaging confirmed proctocolitis and pancreatitis. Labs showed lipase 1337 U/L, hemoglobin 10.9, and thrombocytosis. She was treated with Solu-Medrol and discharged on a prednisone taper, which she discontinued prematurely. In February 2025, she reported recurrent arthralgia, enthesitis, and skin rash. Colonoscopy revealed pancolitis with mild disease activity (UCEIS score 4). Histopathology confirmed chronic active colitis, most severe in the rectum. Sulfasalazine was discontinued due to nausea and headache. She underwent pre-biologic evaluation and was initiated on corticosteroids with plans to escalate therapy based on disease severity. Discussion: This case highlights the importance of recognizing medication-induced pancreatitis in UC and the risks of non-adherence to corticosteroid therapy. A comprehensive evaluation—including imaging, endoscopy, histopathology, and pre-biologic screening—is critical for optimal treatment decisions. Early consideration of biologic therapy in moderate disease, particularly in patients with extraintestinal manifestations and corticosteroid dependence, is essential. Sulfasalazine-induced pancreatitis and premature steroid discontinuation can complicate UC management. Multidisciplinary care and early transition to biologic therapy should be considered in patients with uncontrolled disease and adverse medication reactions.