Patients with end-stage kidney disease (ESKD) often have gastrointestinal presentations, including diarrhea, which has a variety of etiologies [
1,
2]. Patients with ESKD have a greater risk of
Clostridium difficile-associated diarrhea (CDAD) [
3,
4] and ischemic colitis [
5], which are reportedly associated with immune dysfunction [
6‐
8] and atherosclerotic cardiovascular disease, respectively [
9]. One of the rare causes of diarrhea is ulcerative colitis (UC), which is an idiopathic, chronic inflammatory disorder of the colonic mucosa [
10]. UC generally involves the rectum and proximal colon with a continuous and non-segmental distribution and is characterized by biopsy features such as cryptitis with crypt abscesses [
11,
12]. However, these findings are not always specific to UC [
13] and atypical cases with rectal sparing or segmental distribution have been reported [
14]. Moreover, the clinical features of UC sometimes overlap with other relatively common causes of diarrhea, such as CDAD and ischemic colitis [
15,
16]. Therefore, UC with atypical features can be extremely difficult to diagnose correctly in a patient with ESKD. Herein, we present a rare case of a patient with ESKD, in whom UC was obscured by overlap with CDAD and suspected ischemic colitis.