Abstract
We present the case of a patient with severe ulcerative colitis treated with infliximab that was admitted for an extensive facial ulceration located on the left cheek. Pyoderma gangrenosum, bacterial, mycobacterial and fungal infection were taken into account. The patient was diagnosed with a Klebsiella abscess originating from a tooth infection. Infectious complications might arise more frequently in IBD patients treated with anti TNF and adequate diagnosis and therapy is required.
Highlights
We present the case of a patient with severe ulcerative colitis treated with infliximab that was admitted for an extensive facial ulceration located on the left cheek
A 51-year-old male with underlying ulcerative colitis presented to our hospital for a rapidly progressing facial lesion affecting the left cheek (Figure 1) and multiple painful erythematous nodules located predominantly on the chest, left knee and first left metatarsophalangeal joint
A wide differential diagnosis should be discussed when talking about a trans mural facial ulceration, especially in an immunocompromised patient
Summary
A 51-year-old male with underlying ulcerative colitis presented to our hospital for a rapidly progressing facial lesion affecting the left cheek (Figure 1) and multiple painful erythematous nodules located predominantly on the chest, left knee and first left metatarsophalangeal joint. The patient was diagnosed with severe and extensive ulcerative colitis in 2016 and since February 2018 was treated with Infliximab (5mg/kg intravenous perfusion every 8 weeks). On admission the laboratory analysis showed leukocytosis, neutrophilia, severe iron deficiency anemia and intense inflammatory syndrome, without any other abnormal test results. The head CT scan showed a 38/21/8mm lesion with important densification of the subcutaneous tissue of the left cheek associated with left cervical pneumatoceles (Figure 2&3). A skin nodule biopsy showed areas of necrosis with neutrophil debris
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