63. A case of enteropathic arthritis: or is it?

Magda Al-Zaza,Alexander Khakwani,Mohammed Abid Yusuf

doi:10.1093/rap/rky034.026

Abstract

63. A case of enteropathic arthritis: or is it?

Highlights

This is an interesting case regarding a lady that initially presented with painful discoloured digits
Autoimmune screens were initially normal, anti-Ro antibody subsequently became strongly positive and anti-PL12 later returned positive in keeping with a diagnosis of anti-synthetase syndrome
The digital ischaemia progressed to digital necrosis of the finger tips and progressive shortness of breath lead to high resolution ct of chest showing cryptogenic organising pneumonia which had not been on imaging one month prior

Summary

Introduction

A young lady presented with a progressive history of abdominal cramping and passing blood and mucusper rectum. Interspersed between these clinical reviews, she saw different GPs and made two visits to the ED when she was prescribed 5-7 day courses of prednisolone 30mg daily, which helped her joint pain but not the abdominalpain She presented to the ED a week after the rheumatology review with bilateral lower limb purpuric rash along with her ongoing abdominal cramps. Discussion: A young patient presenting with abdominal cramping especially post-prandial,blood and mucuspassageperrectum alongwithpolyarthritis and inflammatory eye disease certainly would have IBD high on the differential diagnosis list. This seems to have led to the delay in diagnosing this lady correctly, and the turning point only came when she developed a purpuric rash. She was managed as having HSP, she had appropriate investigations simulataneously to ruleout other causes