A Rare Case of Giant Filiform Polyposis in a Known Case of Ulcerative Colitis

Background: Filiform polyposis is a rare manifestation of inflammatory bowel disease (IBD), particularly ulcerative colitis, presenting as multiple slender, worm-like mucosal projections. Despite its neoplastic mimicry on imaging and endoscopy, filiform polyposis is considered benign.Case Presentation: We report a rare case of a 61-year-old male with a 10-year history of ulcerative colitis who presented with generalized abdominal pain and rectal bleeding. Colonoscopy revealed extensive pseudopolyps with synechiae predominantly in the ascending and transverse colon. A total proctocolectomy was performed due to disease severity and suspicion of neoplasia. Histopathology revealed classic features of filiform polyposis without dysplasia or malignancy. Conclusion: This case highlights the importance of recognizing filiform polyposis as a rare benign sequela of ulcerative colitis that may mimic malignancy. Early recognition is crucial to avoid overtreatment.