Severe Pancolitis Presenting with Sacroiliitis: A Case Highlighting the Gut-Joint Axis in Ulcerative Colitis

We describe a 32-year-old man without gastrointestinal symptoms who presented with chronic fatigue and a two-week history of severe lower back pain. MRI revealed bilateral sacroiliitis, and positive fecal inflammatory markers led to colonoscopy, which showed pancolitis. Further histopathological testing confirmed the diagnosis of ulcerative colitis (UC). He was treated with upadacitinib to address both conditions, resulting in significant improvement in symptoms and inflammatory markers within two months. This case emphasizes the importance of considering inflammatory bowel disease (IBD) in uncommon extraintestinal presentations.