Adalimumab 40 mg weekly achieves sustained remission in steroid-dependent SCAD with concomitant UC

Segmental colitis associated with diverticulosis (SCAD) is a rare inflammatory condition localized to colonic segments with diverticulosis. Its co-occurrence with ulcerative colitis (UC) is exceptionally rare, presenting significant diagnostic and therapeutic challenges. Standard treatments often fall short, leaving patients with refractory disease. This case addresses the therapeutic gap for patients with this complex dual diagnosis, particularly when conventional therapies like mesalazine and vedolizumab have failed to control inflammation.

This case report details a 56-year-old woman with a history of sigmoidectomy for recurrent sigmoid diverticulitis. She subsequently developed SCAD in residual diverticula near the anastomosis, alongside concomitant left-sided UC. Initial treatments with mesalazine and vedolizumab failed to achieve remission for SCAD, despite rectal healing of UC. The patient was then treated with the anti-TNF antibody adalimumab, with the dose intensified to 40 mg weekly. Clinical, endoscopic, and histologic assessments were performed to monitor disease activity and response to therapy over a 5-year follow-up period.

Intensified therapy with adalimumab 40 mg weekly led to a remarkable therapeutic response in this complex case. The patient achieved complete clinical, endoscopic, and histologic remission of both SCAD and UC. This remission was sustained for 5 years of follow-up, during which the patient remained steroid-free and reported no adverse events. This outcome highlights the potent anti-inflammatory effects of anti-TNF therapy in challenging inflammatory bowel conditions. The previous treatments, mesalazine and vedolizumab, had failed to control the SCAD component of her disease.

The patient remains in sustained, steroid-free remission without adverse events at five years of follow-up to date.