Intestinal Ultrasound in Acute Severe Ulcerative Colitis Treated with Intravenous Cyclosporine: Case Series

Background: Intestinal ultrasound (IUS) has been studied to assess therapeutic response in patients with acute severe ulcerative colitis (ASUC). However, there is no data on sonographic changes occurring in ASUC receiving intravenous (IV) cyclosporine. This case series aims to describe the sonographic changes occurring in hospitalized patients with ASUC receiving IV cyclosporine as salvage therapy. Methods: This is a retrospective observational study in a single tertiary care center from February 2023 to May 2024. Serial sonographic findings of patients with severe UC treated with IV cyclosporine were collected. Sonographic changes associated with clinical outcomes were analyzed. Outcomes included clinical response (Simple Clinical Colitis Activity Index decrease of ≤3 at day 3 with discharge on oral cyclosporine) and colectomy. Results: Nine patients received IV cyclosporine with IUS monitoring; 67% failed ≥2 advanced therapies. Four responded to cyclosporine, four underwent colectomy, and one switched to upadacitinib with a subsequent response during the same admission. Clinical responders had a median 31.8% (IQR 26.3-51.2) reduction in bowel wall thickness (BWT) and 1-scale reduction in modified Limberg score, whereas non-responders demonstrated 7.2% (IQR 54.8-9.0) reduction in BWT and no change in modified Limberg score. The median time to clinical response was 2.5 days (IQR 1.8-2.6). Baseline BWT was similar between responders and non-responders: 5.2 mm (IQR 3.5-6.5) versus 5.2 mm (3.8-6.7). Conclusions: A median 31.8% BWT reduction was observed by day 3 among responders, highlighting early sonographic changes associated with response to IV cyclosporine therapy in refractory ASUC.