INTRODUCTION: Traumatic spinal cord injury (SCI) tetraplegics are at an increased risk of deep venous thrombosis (DVT) due to immobility and altered hemostasis. Inflammatory bowel diseases such as ulcerative colitis (UC) face an elevated risk of thrombotic events due to chronic inflammation, in addition to the risk of diarrhea and bleeding. The case report underscores the potentially additive prothrombotic effects of ulcerative colitis and tetraplegia.

CASE PRESENTATION: A 53-year-old male with UC and traumatic R C3 L C4 sensory, R C3 L C5 motor ASIA impairment C tetraplegia, developed a below the knee DVT during inpatient rehabilitation, despite DVT prophylaxis. Due to potential risk of progression, interventions ultimately included serial ultrasound examinations, IVC filter, and anticoagulation. However, due to bleeding complications, anticoagulation was discontinued, followed by worsening of DVT to the bilateral lower extremities which advanced above the knees. Subsequently, the patient developed clostridium difficile infection, further exacerbating his ulcerative colitis. Bowel program was impacted, and treatment was provided for both clostridium difficile and ulcerative colitis.

DISCUSSION: Both UC and traumatic SCI increase have risk of thrombosis. UC exacerbations and bleeding pose challenges in the treatment of DVT. The need to discontinue anticoagulation due to bleeding risk led to a significant progression of the DVT. SCI bowel program required careful adjustments in the setting of an UC exacerbation, likely triggered by clostridium difficile infection.