S4964 From Remission to Relapse: UC Flare Triggered by Rotavirus in a Patient Who Discontinued Infliximab for a Carnivore Diet

Introduction: Specialty diets are increasingly explored as adjunctive or alternative approaches in managing inflammatory bowel disease. While some diets may support symptom relief and gut health, the evidence for their efficacy is mixed and often anecdotal. This case highlights a young patient with ulcerative colitis who discontinued long-standing infliximab therapy in favor of a strict carnivore diet, and experienced disease relapse following a bout of gastroenteritis. Case Description/Methods: A 22-year-old man with a history of ulcerative pancolitis since 2018 and leukocytoclastic vasculitis was in clinical and endoscopic, but not histologic remission, biopsies from his most recent colonoscopy revealed inflammation in the ascending and descending colon, on infliximab 10 mg/kg every 8 weeks. Against medical advice, he discontinued infliximab and adopted a carnivore diet consisting solely of meat, with occasional fruit, and no vegetables or fiber. For the next 5 months, he remained asymptomatic off therapy. He then presented to the emergency department with abdominal pain and diarrhea. Initial labs were unremarkable, and he was discharged with a prednisone taper. The following day, a GI pathogen panel returned positive for rotavirus, prompting a switch from prednisone to budesonide. However, his symptoms worsened, with rectal bleeding and inability to tolerate oral intake. On readmission, inflammatory markers were elevated (C-reactive protein 196 mg/L, erythrocyte sedimentation rate 28 mm/hr) and computed tomography imaging revealed severe pancolitis. He was started on intravenous hydrocortisone. After 3 days without clinical improvement, he was re-initiated on infliximab and subsequently experienced significant clinical recovery. He was discharged following symptom resolution after 1 infusion. Discussion: This case underscores the fact that specialty diets such as the carnivore diet are not substitutes for evidence-based medical therapy in inflammatory bowel disease. Some diets, such as the Crohn’s Disease Exclusion Diet and the Mediterranean diet, have shown benefits in selected populations, but robust evidence remains limited. Sole reliance on diet, particularly in moderate to severe disease, carries risks of relapse and serious complications. Dietary modifications may play a supportive role but should complement, not replace, standard treatments under medical supervision.