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August 6, 1982

Salmonellosis Complicating Ulcerative Colitis: Treatment With Trimethoprim-Sulfamethoxazole

JAMA. 1982;248(5):584-585. doi:10.1001/jama.1982.03330050066035

IDIOPATHIC ulcerative colitis is a chronic inflammatory disease of the rectum and part or all of the colon characterized by remissions and exacerbations and manifested by abdominal pain, diarrhea, and rectal bleeding. Acute episodes may rapidly progress to a medical emergency with the development of toxic megacolon. An accurate diagnosis is mandatory, yet there are no pathognomonic characteristics, either clinical or histological. Identical features may be seen with specific infections such as Salmonella, Shigella, Campylobacter, Clostridium difficile, Neisseria gonorrhoeae, amebiasis, or in Crohn's colitis.1 Usually no precipitating factor for acute relapse can be determined.2 The case to be described illustrates the importance of recognizing a precipitating factor associated with a fulminant relapse of ulcerative colitis.

Report of a Case  A 22-year-old woman with a diagnosis of ulcerative colitis had been followed up for four years; she had been asymptomatic for one year, while receiving sulfasalazine, 3 g/day. Five