Sterile Nasal Septal Abscess in Ulcerative Colitis With Crypt Abscess-Like Neutrophilic Infiltration

We report a rare case of a sterile nasal septal abscess (NSA) occurring as an extraintestinal manifestation of ulcerative colitis (UC), accompanied by a novel histopathologic finding. A 40-year-old woman with relapsed UC presented with nasal swelling, purulent discharge, hematochezia, and skin lesions. Computed tomography revealed an anterior NSA, and emergent endoscopic drainage was performed. Despite broad-spectrum antibiotics, her condition worsened, and corticosteroids were initiated. Histopathologic analysis of the nasal mucosa demonstrated crypt abscess-like neutrophilic infiltration within glandular structures, resembling colonic crypt abscesses in active UC. Cultures were negative, and her condition improved with immunosuppressive therapy. To our knowledge, this is the first reported case of a sterile NSA with crypt abscess-like structures in the nasal mucosa, expanding the histopathologic spectrum of sinonasal manifestations in UC. Early recognition and prompt immunosuppressive therapy are essential to avoid complications such as saddle nose deformity.