Achieving Rapid Remission With Guselkumab in a Moderately Active Ulcerative Colitis Patient With High Infectious Risk and Inadequate Response to Advanced Therapy: A Case Report

Ulcerative colitis (UC) with prior inadequate response to advanced therapy (AT-IR) that requires hospitalization is particularly challenging to manage, especially in cases where a high risk of infection limits the use of immunosuppressive agents. A 32-year-old male patient with pancolitis-type UC was refractory to glucocorticosteroids, infliximab, and tacrolimus. His clinical course was complicated by septic shock and invasive candidiasis. Antifungal therapy limited the use of upadacitinib due to drug-drug interactions. After achieving infection control, intravenous guselkumab (200 mg) was initiated. The patient's stool frequency normalized, and hematochezia resolved within two weeks. The patient achieved clinical remission, and he was then discharged. In conclusion, guselkumab achieved clinical remission in a patient with active UC with AT-IR, in whom the risk of infection was high and other advanced therapies were restricted.