OBJECTIVE: Ulcerative colitis is a part of inflammatory bowel disease (IBD) which defined as recurrent chronic inflammatory disease of the colon that extends from the rectum to the proximal area of the colon. The diagnosis based on phenotype typical identification from colonoscopy and biopsy after ruling out enteric infection. This study aims to describe the clinical extra-intestinal manifestation of ulcerative colitis post infection.
 
CASE: A 4-year-old boy admitted in Dr. Cipto Mangunkusumo General Hospital with severely malnutrition, gastro esophageal reflux disease (GERD), and chronic bloody diarrhea. He was previously got high fever and hospitalized in Distric hospital, and started having chronic diarrhea after father giving him crushed-fresh earthworm as traditional medication. On colonoscopy there was ulcerated rectosigmoid area extending to ascending colon with friable and bleeding mucosa, and also multiple polyposis those have been taken by snare and coagulation procedure in several-scheduled times. The pathology showed infective colitis and inflammatory polyps. Afterwards, the colonoscopy appearance became normalized, no polyps, with healing ulcers.

Initially he was treated for his dehydration, infection, and nutrition with MCT formula. His symptoms improved and achieved good nutritional status. However the inflammatory process continue and manifest as IBD related arthritis, iron deficiency anemia, and osteopenia that resulting in adjustment disorder. After managed by pediatrics team consist of several sub-discipline such as gastroenterologist, endocrinologist, allergy-immunologist, social-pediatrics, and psychiatrist; he grows well. Evaluation of PedsQl between December 2018 and April 2019 showed improvement.

CONCLUSION: Infectious chronic diarrhea should be treated properly in order to prevent post infection inflammation such as ulcerative colitis that could manifest extra-intestinally.