Targeted Rescue Therapy in Refractory Ulcerative Proctitis: A Case Report on Tacrolimus Enema

Background: Ulcerative proctitis, a localized subtype of ulcerative colitis (UC), is generally managed with mesalamine therapies. However, some patients fail to respond and require alternative strategies. Among emerging treatments, topical tacrolimus offers potent localized immunosuppressive effects with minimal systemic exposure. We prese Case Presentation: nt a case involving a 37-year-old woman with a 10-year history of ulcerative proctitis who experienced a flare-up with rectal bleeding and increased stool frequency. Her symptoms did not improve despite optimized oral and rectal mesalamine therapy and a short course of antibiotics. The baseline Mayo score was 10, and the UCEIS score was 7, both indicating severe disease activity. Sigmoidoscopy showed grade 3 proctitis, with signs of active inflammation. The patient was started on a once-daily tacrolimus enema (4mg/60 mL) while continuing oral mesalamine. Within 10 days, her symptoms improved significantly; bowel movements normalized, and bleeding resolved. A follow-up sigmoidoscopy revealed near-complete mucosal healing, now consistent with grade 1 proctitis. No adverse effects were observed during treatment. Tacrolimus enema is a Conclusion: safe and effective option for treating refractory ulcerative proctitis. Early intervention may promote rapid remission and reduce the need for systemic corticosteroids.