scholarly journals Pyoderma Gangrenosum as the Initial Presentation of Inflammatory Bowel Disease

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S51-S51
Author(s):  
S S Karimi ◽  
G Guzman
Keyword(s):  
Inflammatory Bowel Disease ◽  
Lower Extremity ◽  
Pyoderma Gangrenosum ◽  
Crohn Disease ◽  
Lupus Erythematosus ◽  
Bowel Disease ◽  
Bacterial Colonization ◽  
Neutrophilic Dermatosis ◽  
Tissue Destruction ◽  
Inflammatory Bowel

Abstract Introduction/Objective Pyoderma gangrenosum is a neutrophilic dermatosis, commonly associated with arthritis, psoriasis, and systemic lupus erythematosus. It is also an aggressive manifestation of extra-intestinal inflammatory bowel disease affecting less than 5% of patients with ulcerative colitis and Crohn disease. We present a case of pyoderma gangrenosum as an initial and rapidly progressive manifestation of Crohn disease. Methods A 35-year-old man presented with fecal urgency, periumbilical pain, and frequent diarrhea, with stool cultures revealing no infectious etiology. Colonoscopy demonstrated active inflammatory bowel disease consistent with Crohn disease. Concurrently, patient developed an ulcer on right lower extremity not otherwise contributed to history of trauma or injury. Biopsy of right lower extremity ulcer revealed histopathologic findings consistent with pyoderma gangrenosum. Despite medical management, and prolonged use of wound care and wound vac, patient’s non-healing ulcer continued to geographically expand, resulting in ankle contracture. A right below the knee amputation was performed and amputation specimen was sent to pathology for further diagnostic evaluation. Results Gross examination revealed an extensive cutaneous ulcer measuring 22.1cm x 11.7cm x 0.3cm and involving the anterior medial aspect of the right lower extremity with medial and posterior extension down to the dorsum of the foot with broad deep tissue destruction and exposure of fascia and tendon. Microscopic examination revealed severe ulceration, suppurative necrosis, superficial and deep vasculitis confined to the ulcer bed. Surrounding soft tissue revealed chronic myopathic changes secondary to ischemia. Foci of commensal filamentous gram-positive bacterial colonization in a nidus of necrosis were also identified. The inflammatory pattern involved predominantly neutrophils with weak recruitment of other inflammatory cells, consistent with pyoderma gangrenosum. Conclusion This case highlights the debilitating extent of Crohn disease, its detrimental effects on the patient’s quality of life, and the diagnostic and treatment challenges it poses to clinicians in managing Crohn disease and its complications.

scholarly journals Pyoderma Gangrenosum as a Presenting Feature of Undifferentiated Spondyloarthropathy with Erosive Inflammatory Arthritis

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Jaspreet Kaler ◽  
Sandra Sheffield ◽  
Myint Thway ◽  
Karishma Ramsubeik ◽  
Gurjit Kaeley
Keyword(s):  
Inflammatory Bowel Disease ◽  
Lower Extremity ◽  
Pyoderma Gangrenosum ◽  
Bowel Disease ◽  
Inflammatory Arthritis ◽  
Sexually Transmitted ◽  
Clinical Presentations ◽  
Axial Spondyloarthropathy ◽  
Rapid Healing ◽  
Inflammatory Bowel

Pyoderma gangrenosum is a rare inflammatory condition with varying clinical presentations and severity. It is commonly seen in association with an underlying condition, most common of which is inflammatory bowel disease. We report a case of a 26-year-old male who came to the emergency department with increasing lower extremity ulcers, intermittent hematochezia, and pain in the small joints of his hands. After excluding a broad list of differentials for lower extremity ulcers, the diagnosis of pyoderma gangrenosum was made. He was also found to have erosive changes at multiple proximal interphalangeal joints and jug-like syndesmophytes at T12 and L1 on CT scan. Although there was evidence of a spondyloarthropathy, there was no evidence of inflammatory bowel disease on colonoscopy, psoriasis, or sexually transmitted infections. After multiple failed trials of medications including azathioprine and sulfasalazine, 4 weeks of Adalimumab resulted in rapid healing of pyoderma gangrenosum lesions and improvement in his synovitis. Coupled together, this suggests a diagnosis of pyoderma gangrenosum associated with undifferentiated spondyloarthropathy and erosive inflammatory arthritis. This case is suggestive of spondyloarthropathy going underdiagnosed and untreated in other patients with pyoderma gangrenosum as lower extremity ulcerations can be the primary complaint for seeking treatment. Although rare, axial spondyloarthropathy associated with pyoderma gangrenosum should be kept as an associated differential diagnosis when faced with pyoderma gangrenosum.

“Inflammatory Bowel Disease—Not Just the Bowel’s Bane”: Peripheral Arterial and Venous Thrombosis in a Patient With Crohn Disease

2020 ◽  
Vol 54 (7) ◽  
pp. 646-649
Author(s):  
Leora Boussi ◽  
Aditya Safaya ◽  
Arun Goyal ◽  
Romeo Mateo ◽  
Igor Laskowski ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Arterial Thrombosis ◽  
Vena Cava ◽  
Vascular Complications ◽  
Arm Pain ◽  
Inflammatory Bowel

Introduction: Inflammatory bowel disease (IBD) is a chronic multisystem inflammatory condition with associated endothelial dysfunction and dysregulated coagulation. Although deep venous thrombosis (DVT) in IBD has been well described, arterial thrombosis and thromboembolism are less commonly appreciated. Methods: A 63-year-old male with a known history of Crohn disease presented with acute-onset right arm pain. His past vascular history was significant for left lower extremity DVT with an existing inferior vena cava filter and acute ischemia of the right lower extremity requiring a below-knee amputation a year ago. Imaging revealed acute brachial, ulnar, and radial artery thrombosis. Results: Patient underwent an open right brachial, radial, and ulnar thrombectomy to restore vascular flow. He required multiple exploration and thrombectomy for reocclusion of the vessels in the early postoperative period. He later developed a rapidly deteriorating clinical status, flank ecchymosis and swelling concerning for soft tissue ischemia, and compartment syndrome heralding an eventual hemodynamic collapse. On exploration, he was found to have chronic fibrosis of his left femoral vein and femoral artery occlusion. Clinically, the patient deteriorated rapidly, which resulted in his demise. Conclusion: The inflammatory reaction in IBD leads to arterial stiffening and hypercoagulability, which should theoretically increase the risk for vascular disease. Although the link between IBD and DVT is well established, arterial thrombosis and thromboembolism remain widely debated, with some implications for therapeutic intervention. The link between vascular thrombosis and IBD must be examined further, as the treatment and prevention of vascular complications in IBD depends on our understanding of this relationship.

scholarly journals A156 SERUM TUMOUR NECROSIS FACTOR-α ANTAGONIST DRUG CONCENTRATIONS IN PATIENTS WITH PYODERMA GANGRENOSUM ASSOSCIATED WITH INFLAMMATORY BOWEL DISEASE

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 162-163
Author(s):  
M Mikail ◽  
A Wilson
Keyword(s):  
Inflammatory Bowel Disease ◽  
Pyoderma Gangrenosum ◽  
Bowel Disease ◽  
Complete Resolution ◽  
Therapeutic Drug ◽  
Drug Concentrations ◽  
Median Serum ◽  
Inflammatory Bowel ◽  
Factor Α ◽  
Necrosis Factor

Abstract Background The utility of therapeutic drug monitoring for guiding the dosing of tumor necrosis factor-α antagonists (TNFAs) in luminal inflammatory bowel disease (IBD) is well-established and well-accepted. TNFAs, specifically infliximab and adalimumab, have become integral to the management of the rare, neutrophilic dermatosis, pyoderma gangrenosum (PG) in IBD. Little is known regarding the target serum TNFA concentrations to guide dosing to achieve resolution of PG in IBD. Aims To describe the serum TNFA concentrations (infliximab or adalimumab) associated with the resolution of PG lesions in patients with IBD. Methods Patients with IBD and associated PG treated with one of infliximab or adalimumab (collectively known as TNFAs) seen at two academic hospitals affiliated with Western University were identified. Serum TNFA concentrations were assessed at the time of PG treatment. Results Nine patients were identified. All patients had IBD-associated PG. Seven patients were treated with infliximab and 2 patients were treated with adalimumab. All patients received standard dosing. Eight patients had complete resolution of their PG, while one had near complete resolution at the time of last follow-up. A median serum infliximab concentration of 3.00 (IQR, 3.52) µg/ml at week 14 and a median serum adalimumab concentration of 2.02 (IQR, 0.98) µg/ml at week 12 were seen at the time of PG treatment. Conclusions Herein, we report low serum TNFA concentrations despite PG healing in a cohort of IBD patients. This is lower than what is in patients for successful TNFA treatment in luminal and fistulising IBD. Funding Agencies NoneNone.

Intravenous Cyclosporine in Refractory Pyoderma Gangrenosum Complicating Inflammatory Bowel Disease

2001 ◽  
Vol 7 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Sonia Friedman ◽  
James F. Marion ◽  
Ellen Scherl ◽  
Peter H. Rubin ◽  
Daniel H. Present
Keyword(s):  
Inflammatory Bowel Disease ◽  
Pyoderma Gangrenosum ◽  
Bowel Disease ◽  
Inflammatory Bowel

Clostridium Difficile Infection and Biliary Obstruction

2021 ◽  
Vol 8 (1) ◽  
pp. 01-06
Author(s):  
Marilena Stoian
Keyword(s):  
Inflammatory Bowel Disease ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Biliary Obstruction ◽  
Hepatobiliary Disease ◽  
Protein Loss ◽  
Protein Losing Enteropathy ◽  
Inflammatory Bowel

We present a case of a 38-year -old man was admitted to the hospital with biliary obstruction and Clostridium Difficile infection. He presented with moderate increases in the aminotransferase and bilirubin levels suggesting the diagnosis of an autoimmune hepatobiliary disease; intestinal protein loss needs to evaluate an associated inflammatory bowel disease. The clinical diagnosis of autoimmune hepatobiliary disease associated with inflammatory bowel disease is based on the patients symptoms and the presence of a protein-losing enteropathy which are more suggestive of Crohn disease, while moderate increases in the aminotransferase levels in proportion to the increase in the bilirubin level suggesting the diagnosis of primary sclerosing cholangitis. The pathological and positive diagnosis needs an endoscopic retrograde cholangiopancreatography and a biopsy of gastric and duodenum mucosae who showed severe inflammation findings that are diagnostic of Crohn disease.

Pyoderma Gangrenosum in a Patient with Essential Thrombocythemia

2000 ◽  
Vol 4 (2) ◽  
pp. 107-109 ◽  
Author(s):  
Kim W. King ◽  
Alexander Murray
Keyword(s):  
Inflammatory Bowel Disease ◽  
Pyoderma Gangrenosum ◽  
Essential Thrombocythemia ◽  
Bowel Disease ◽  
Hematologic Disease ◽  
Inflammatory Bowel

Background: Pyoderma gangrenosum is an uncommon ulcerative condition associated with inflammatory bowel disease, arthritis, and hematologic disease. We report a patient with essential thrombocythemia and pyoderma gangrenosum. Objective: This article is a review of the associations between pyoderma gangrenosum and other diseases. Results: There have been two previous reports of patients with pyoderma gangrenosum and essential thrombocythemia. Conclusion: There may be a possible association between pyoderma gangrenosum and essential thrombocythemia. The diagnosis of pyoderma gangrenosum should be considered in patients with essential thrombocythemia and cutaneous ulcers.

scholarly journals Treatment of Pyoderma Gangrenosum in Pediatric Inflammatory Bowel Disease

JPGN Reports ◽  
2020 ◽  
Vol 1 (2) ◽  
pp. e008
Author(s):  
Katherine Vaidy ◽  
Rebecca Winderman ◽  
Simon S. Rabinowitz ◽  
Steven M. Schwarz
Keyword(s):  
Inflammatory Bowel Disease ◽  
Pyoderma Gangrenosum ◽  
Bowel Disease ◽  
Pediatric Inflammatory Bowel Disease ◽  
Inflammatory Bowel

scholarly journals Trauma and the pyoderma gangrenosum of inflammatory bowel disease

Gut ◽  
1981 ◽  
Vol 22 (5) ◽  
pp. 410-412 ◽  
Author(s):  
S I Finkel ◽  
H D Janowitz
Keyword(s):  
Inflammatory Bowel Disease ◽  
Pyoderma Gangrenosum ◽  
Bowel Disease ◽  
Inflammatory Bowel

Systemic lupus erythematosus with inflammatory bowel disease-ulcerative colitis: case report

Lupus ◽  
2018 ◽  
Vol 27 (7) ◽  
pp. 1198-1201
Author(s):  
H Elsayed Mansour ◽  
S Gamal Arafa ◽  
W Abdelfatah Shehata
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Lupus Erythematosus ◽  
Bowel Disease ◽  
University Hospital ◽  
Small Vessel Vasculitis ◽  
Antibody Testing ◽  
Systemic Lupus ◽  
Inflammatory Bowel

A 30-year-old female presented to the rheumatology outpatient clinic of the Internal Medicine Department, Ain Shams University Hospital, Cairo, Egypt, complaining of a large right leg ulcer consistent with pyoderma gangrenosum. There was history of recurrent attacks of bleeding per rectum of one-year duration. During hospitalization she noticed blurring of vision in the left eye with diffuse blackish discoloration of the feet and toes, consistent with small-vessel vasculitis. Colonoscopy with biopsy and histopathology confirmed the diagnosis of inflammatory bowel disease-ulcerative colitis (IBD-UC). Meanwhile, the patient fulfilled the SLICC classification criteria for systemic lupus erythematosus (SLE): recurrent oral ulcers, positive antinuclear antibody testing, proteinuria >0.5 gm/24-hour urine, positive test for lupus anticoagulant and consumed C3 complement component. Herein we report a rare case of coexistence of SLE and IBD-UC.

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