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[Ulcerative colitis complicated by multiple aseptic subcutaneous abscesses: a case report].

Mariko Kobayashi1, Kazuto Ikezawa1, Kentarou Iwai1

  • 1Division of Gastroenterology, Tsukuba Memorial Hospital.

Nihon Shokakibyo Gakkai Zasshi = the Japanese Journal of Gastro-Enterology
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Summary

A rare case highlights pyoderma gangrenosum (PG) presenting as aseptic subcutaneous abscesses in a patient with ulcerative colitis (UC). Early diagnosis and treatment of PG, an extraintestinal manifestation of UC, are crucial for rapid improvement.

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Area of Science:

  • Gastroenterology
  • Dermatology
  • Internal Medicine

Background:

  • Ulcerative colitis (UC) is a chronic inflammatory bowel disease.
  • Pyoderma gangrenosum (PG) is an inflammatory skin condition and a known extraintestinal manifestation of UC.
  • PG typically presents with characteristic skin ulcers, but atypical presentations exist.

Observation:

  • A middle-aged woman with a history of UC presented with anterior chest pain and worsening systemic symptoms.
  • Initial investigations, including CT scans and skin examinations, were unremarkable.
  • Subsequent imaging revealed multiple aseptic subcutaneous abscesses in the sternal and gluteal regions, alongside evidence of active UC.

Findings:

  • The patient was diagnosed with pyoderma gangrenosum (PG) presenting solely as subcutaneous abscesses, an unusual manifestation of UC.
  • Prompt initiation of steroid therapy led to rapid improvement in both the patient's general condition and the subcutaneous abscesses.
  • This case underscores that PG can manifest without typical skin ulcerations.

Implications:

  • Subcutaneous abscesses in UC patients may represent an early or atypical form of PG.
  • Delayed diagnosis and treatment of such presentations can lead to progression to more severe ulcerative PG.
  • Clinicians should consider extraintestinal manifestations like PG in UC patients, even with non-specific symptoms, for timely intervention.