CC: Abdominal pain, bloody diarrhea
ID: 29 yo F with history of eczema presenting with abdominal pain and diarrhea for 1 month. The abdominal pain is described as intermittent, cramping, and diffuse. Her bowel movements changed to watery then bloody, with 3-8 episodes per day. She has associated nausea, vomiting, poor appetite, and 10lb weight loss for the same period of time. Exam findings are pertinent for a new rash on her right thigh that is ulcerative with purulent base (see picture below). Colonoscopy demonstrated a normal rectum but colon had noticeable changes of ulcerations, pseudopolyps, edematous and friable mucosa. Biopsy of affected area confirmed diagnosis of Crohn’s disease and biopsy of skin lesion was consistent with Pyoderma gangrenosum.
Image used with permission from VisualDx
Morning Report Pearls:
1. Always be on the look out for extra-intestinal manifestations when IBD is on the differential. They can appear at various times during the disease course. Here are some:
- Episcleritis, Scleritis, Uveitis
- Peripheral arthritis – Type I and Type II
- Erythema nodusum
- Pyoderma grangenosum
BOLD = correlates with disease activity
2. Skin findings seen in IBD can be seen in a multitude of other conditions.
- Pyoderma grangrenosum can be seen in hematologic malignancies and rheumatologic conditions like RA and AS
- Erythema nodusum can be seen in many different infections – Streptococal infection, TB, Mycoplasma, Cocci, Blasto, Histo as well as in Sarcoid, Behcets, Lymphoma