Abstract
A 40-year old woman with recent asymmetric arthritis and fever was evaluated in our clinic. NSAIDs were recommended, but a few days later she was admitted to our hospital because of worsening arthritis along with the appearance of new skin lesions in both feet. Although she was treated with antibiotics and high dosages of steroids, her arthritis did not improve. The skin lesions progressed from bullous initially to ulcerative pyoderma gangrenosum, so we suggested endoscopic examination of the colon which revealed Crohn’s disease. The patient received I.V. treatment with infliximab resulting in a remarkable response. Some patients with Crohn’s disease may present with extraintestinal manifestations well before the bowel disease is manifested and diagnosed.
Highlights
The combination of arthritis and skin lesions represent a usual presentation in our daily clinical practice
We examined the patient and taking into account the asymmetric arthritis, the pyoderma gangrenosum lesions of the feet and the radiological image of enthesitis of both heel bones (Figure 2), our working diagnosis was a seronegative spondylarthritis
It has been reported that one quarter of patients with inflammatory bowel disease (IBD) may present with extraintestinal manifestations preceding even 5 months -on average- prior to IBD diagnosis.[6,7]
Summary
The combination of arthritis and skin lesions represent a usual presentation in our daily clinical practice. Differential diagnosis includes connective tissue diseases,[2] infections, endocrine,[3] hematologic[4] and malignant diseases[5]
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