Aseptic Abscess Syndrome With Ulcerative Colitis and Pyoderma Gangrenosum

Abstract

A 76-year-old female patient was admitted to our hospital with buttock pain, difficulty in walking, watery diarrhea, melena, abdominal pain, and skin eruption in the lower limbs. Computed tomography revealed abscesses in the right subgluteus maximus and right pectineus. Two weeks of broad-spectrum antibiotics were not effective. The abscesses were still apparent on magnetic resonance imaging acquired at 2 weeks after initiation of antibiotics (Figure A). A lower gastrointestinal endoscopy revealed left-sided ulcerative colitis (Figure B). The skin eruption was diagnosed as pyoderma gangrenosum based on neutrophil-dominant inflammation seen in tissue from skin biopsy (Figure C). No significant bacterial growth was detected in aspiration cultures from the abscess. The final diagnosis was aseptic abscess syndrome by exclusion diagnosis, and subsequent corticosteroid medication resulted in rapid clinical improvement, disappearance of both abscesses (Figure D), and no relapse following immunosuppressive therapy with azathioprine. If multiple deep organ abscess formations occur in patients with inflammatory bowel disease complicated by a neutrophil-induced eruption, regardless of the activity of intestinal lesions, a good prognosis can be obtained by the prompt use of immunosuppressive agents, such as corticosteroids, rather than antibiotics or surgery, with consideration to the possibility of aseptic abscess syndrome. Statement of confirmation: Informed consent was obtained from the patient for the publication of their information and imaging.