Vital signs; body temperature was 36.6?C, blood pressure was 110/70?mmHg, pulse rate was 70beats/min, SpO2: 98% (room air flow). postoperative clinical course. We statement a case of refractory UC individual who underwent subtotal colectomy with COVID-19 contamination, with a review of the literature. Case report Medical history The patient was 60-year-old male without past medical history. In January 2020, he had more than 20 lines of daily bloody diarrhea and frequented a nearby doctor. He was diagnosed as total colitis-type UC by total colonoscopic examination. His symptoms improved with oral 5-aminosalicylic acid (5-ASA). Coughing appeared on the middle of May and dyspnea appeared on the end of May. He frequented a nearby doctor in June and was found abnormal findings on chest X-ray (Fig.?1) and decreased SpO2, and was transferred to the department of respiratory medicine. The SARS-CoV-2 PCR test was negative and the chest CT scan showed interstitial shadows at the base of the lungs and infiltrative shadows in the upper lobes (Fig.?2). He was treated with antibacterial drugs and oral prednisolone (35?mg/day) for the diagnosis of interstitial pneumonia ZEN-3219 caused by 5-ASA, and was discharged from the hospital. However, the relapse of UC occurred during the ZEN-3219 dose reduction of prednisolone (20?mg/day), and azathioprine was started in late June. After self-interruption of the drug, bowel movement with bloody stool was gradually increasing, and he was readmitted to the previous hospital. Colonoscopic examination revealed small ulcers, purulent mucus, and spontaneous bleeding from your descending colon to the rectum with Matts grade 4. High-dose intravenous steroid improved his UC temporarily without remission. During hospitalization, he developed drug-induced pancreatitis (suspicious drugs included azathioprine or levetiracetam, both of which were discontinued) and was treated with continuous infusion and proteolytic enzyme inhibitors. In addition, he developed air flow embolism probably due to central venous catheter removal by himself, and was treated with hyperbaric oxygen therapy and anticonvulsant (levetiracetam). Consciousness level recovered to normal, but upper limb-dominant weakness remained. The UC worsened in a short period of time from your onset with side effects of multiple drugs and progressing malnutrition (Fig.?3a,b). He was transferred to our hospital for the operation because of medical failure of UC ZEN-3219 in August. Open in a separate windows Fig. 1 Chest X-ray findings. Infiltration shadows are observed mainly from your upper to middle lobes on both lungs Open in a separate windows Fig. 2 Chest CT findings. Interstitial opacities at the bases of both lungs and infiltrative opacities predominantly in the upper lobes were IGF1R observed Open in a separate windows Fig. 3 Abdominal CT findings. From your ascending colon to the rectum, thickening of intestine with contrast effect were observed Present symptoms at admission The height was 165?cm, the excess weight was 50?kg (8?kg less than usual). Vital signs; body temperature was 36.6?C, blood pressure was 110/70?mmHg, pulse rate was 70beats/min, SpO2: 98% (room air flow). The abdominal findings were soft and smooth, without spontaneous pain or tenderness, and the bowel frequency of 6 watery stools / day without melena. He had anemia of Hb 9.3?g/dL and was diagnosed moderate ulcerative colitis (partial Mayo score: 5) (Table?(Table.1)..1). Due to the exacerbation of UC and the sequelae of air flow embolism, he could not walk ZEN-3219 and be disturbed of hand movement with handshake of right hand and no movement of left hand (performance status (PS): 4). At the ZEN-3219 time of transfer to our hospital, no taste disorder, olfactory disorder, and respiratory symptoms were observed. Table 1 Blood test findings on admission. Anemia, increased inflammatory response, and marked malnutrition with ALB 1.7 were noted WBC7040 /mlTP5.7?g/dlRBC3.36.