Case Presentation: A 28-year-old female with a history of ulcerative colitis (UC) was hospitalized for surgical evaluation in the setting of refractory colitis. Seven weeks prior to presentation, she developed diffuse proctocolitis (Mayo score 2-3) that progressed despite treatment escalation from oral to intravenous steroids, followed by infliximab induction and mercaptopurine initiation three weeks prior [...]