Abstract
Question: A 62-year-old woman with an 8-year history of fistulizing ileocolonic Crohn's disease (CD) presented to our institution with profuse bleeding from a perianal fistula. The patient has been maintained on oral 5-aminosalicylic acid (5-ASA) since diagnosis and 6-mercaptopurine (6MP) 100 mg/d for the previous 8 months. The patient complained of sudden-onset bleeding from her perianal fistula. Her blood pressure was 105/60 mmHg and pulse rate 102, bpm. Her perianal examination was significant for pyoderma gangrenosum on the skin of her buttock (Figure A) and a large perianal fistula with active bleeding.
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