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[Case Report] Bilateral lower limb weakness in acute severe ulcerative colitis

An obese 49-year-old man with no medical history of note presented in August, 2014, with a 5-week history of bloody diarrhoea, anorexia, and unintentional weight loss. He reported passing 20 bloody stools per day, with nocturnal disturbance, and on admission had pyrexia, tachycardia, anaemia, and a robust inflammatory response. Flexible sigmoidoscopy showed severe confluent colitis, and histopathology confirmed a first presentation of active ulcerative colitis (figure). In view of these findings we started intravenous methylprednisolone 30 mg twice daily for 7 days followed by a standard reducing course of oral prednisolone (40 mg daily, decreasing by 5 mg per week).