Treatment of steroid-dependent rectal sparing ulcerative colitis associated with severe autoimmune hemolytic anemia with oral mycophenolate mofetil--a case report and review of literature

Background: Patients with ulcerative colitis (UC) may experience various type of anemia, in which the most common reasons are dystrophic anemia and hemorrhagic anemia. Autoimmune hemolytic anemia (AIHA) associated with UC is seldom seen, especially Coombs-negative AIHA. Case presentation: Here we report a case of refractory anemia that cannot be explained by UC disease activity in a young male. The patient was infected with cytomegalovirus (CMV). Colonoscopy showed diffuse polypoid hyperplasia with the absence of rectal involvement. Although the UC was in remission from steroid or total enteral nutrition, but the anemia is getting worse. The Coombs test showed negative, who is subsequently diagnosed by warm autoantibodies of IgA type and treated with mycophenolate mofetil (MMF) 2g daily. Both UC and AIHA were improved from treatment. Conclusion: AIHA can be secondary to UC, infection, or drugs, in which IgA autoantibody AIHA is a special situation. When gastroenterologist and Immunologist, and hematologist encounter patients with "negative" Coombs test acquired hemolytic anemia, AIHA should be considered in the differential diagnosis. MMF may be an option for the treatment of UC patients with AIHA.