A 33-year-old pregnant woman with ulcerative colitis presented at 10 weeks of gestation with fever, nausea, vomiting, abdominal pain, and headache. On hospital day 3, the systolic blood pressure declined to 70 mm Hg. Three weeks earlier, the patient had had an ulcerative colitis flare; methylprednisolone and mesalamine were administered. A diagnosis was made.