Uneventful pregnancy and neonatal outcome with tacrolimus in refractory ulcerative colitis

Tacrolimus is currently approved only in patients receiving allogeneic liver or kidney transplants.1 We and others have demonstrated its successful use in refractory colitis.2,3 Here we report the first patient who was successfully maintained in remission during pregnancy and delivered a healthy baby. Our patient was diagnosed with ulcerative colitis at the age of 25 years. Her first baby was delivered by Caesarean section prematurely at 29 weeks’ gestation. Frequent flare ups of her pancolitis required repeated steroid rescue and she was soon started on azathioprine. Unfortunately, she was unable to tolerate purine analogues due to heterozygous thiopurine methyltransferase deficiency causing severe pancytopenia and life threatening sepsis. Discussing the remaining therapeutic options, the patient refused proctocolectomy and ileoanal pouch anastomosis and chose a trial …