My daughter has UC. Is mucus in stool a flare warning sign?

Question

Hello doctor,

My daughter is your old patient. Just to recall, she had ulcerative colitis. She was taking tablet 6-MP 25 mg every other day along with folic acid. After the colonoscopy, you suggested a 25 mg tablet of 6-MP each day with 2 gm Pentasa and 5 mg folic acid. We did a couple of blood tests after a few months. The other doctor felt her liver markers were elevated and reduced the dose of the 6-MP tablet. We were not sure how to contact you, so we followed her. After that, we did one more blood test. There was no increase in WBC or RBC.

But now, nearly a month and a half later, she is taking 25 mg every other day, and we are seeing white mucus in her stools on and off. She has no belly pain or other symptoms. Frequency is mostly one time a day, and for the last couple of days, it has been twice a day with formed stool. We will be doing one more blood test tomorrow. I am uploading the first two blood test reports now. I will send the next one when it is available.

Her current medication is tablet 6-MP 25 mg every other day, Rowasa 2 gm per day, and folic acid 5 mg per day. In the last six months, we have done three calprotectin stool tests. The values were 363, 70 (after four months), and 33 (after two months), respectively.

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

After reviewing the history, keeping her condition of ulcerative colitis under consideration, it looks like an overdose of 6-MP (Mercaptopurine). I suggest you continue the 6-MP tablet on alternate days. The LFT (liver function tests) report was normal. Occasional mucus in stool can be ignored.

I suggest you repeat the calprotectin stool test and LFT. Please send me the reports and watch for blood in her stools.

HB (hemoglobin) is normal.

Need not worry, as she is in remission. I suggest you to continue Pentasa (Mesalazine) 2 gm daily and folic acid.

I also suggest that you kindly give her a vitamin B12 injection and take advice from your gastroenterologist.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

Reports were noted (attachments removed to protect the patient's identity). I can see that-

1. CRP (C-reactive protein test) is normal.

2. Vitamin levels are low, so I suggest you give her some supplementation.

3. High 6-MP metabolites are present, so I suggest you continue the lower dose.

I will review with fecal calprotectin report.

I hope this helps.

Thank you.