Association Between Ulcerative Colitis and Pulmonary Embolism: A Case Report

Abstract

Introduction: Inflammatory bowel diseases (IBD) include Crohn’s disease (CD) and ulcerative colitis (UC), conditions that primarily affect the intestines but can sometimes lead to extraintestinal complications such as venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE).

Case Report: A 39-year-old woman was admitted with a 12-hour history of left-sided chest pain radiating to the ipsilateral scapular region, worsened by breathing and positional changes. She reported a prior episode of deep vein thrombosis in her right leg. Laboratory tests revealed microcytic hypochromic anemia and thrombocytosis. Imaging studies showed findings suggestive of pulmonary infarction, with a CT pulmonary angiogram confirming a thrombus at the segmental branch of the right lower lobe, accompanied by right-sided pleural effusion and atelectasis. Further evaluation for anemia, including a colonoscopy, revealed acute-phase pancolitis with minimal bleeding. An autoimmune panel was negative. Treatment was initiated with anticoagulation, mesalazine, and methylprednisolone.

Conclusions: Thromboembolic complications occur in approximately 1% to 8% of patients presenting with active inflammatory bowel disease and are associated with increased morbidity and mortality. The underlying pathophysiological mechanisms likely involve a hypercoagulable state, platelet aggregation, impaired fibrinolysis, and genetic predisposition. Identifying risk factors and implementing appropriate therapeutic measures are crucial to preventing future thromboembolic events. The preferred prophylactic anticoagulation therapy is low-molecular-weight heparin, which is recommended for hospitalized patients at high risk during active disease phases.