A refractory case of ulcerative colitis developed after the cessation smoking achieved clinical and endoscopic remission after resuming smoking

Abstract

A 42-year-old man, who had stopped smoking almost one year ago, visited our hospital for hematochezia. He was diagnosed as having ulcerative colitis and was prescribed 5-Amino salicylic acid and corticosteroids, which led to the remission of his disease. However, the disease relapsed after sufficient continuous corticosteroids administration and persisted despite 5-Amino salicylic acid administration and intensive treatment with corticosteroids, immune modulators, leukocyte apheresis, and anti-TNF-A antibodies. Curiously, clinical remission was achieved after he resumed smoking, and colonoscopy revealed mucosal healing. Such remission may be attributable to anti-inflammatory effects of smoking nicotine and carbon oxides.