Scattered Skin Eruptions in a Patient With Inflammatory Bowel Disease

February 2021 in “ Gastroenterology ”

Anand Kumar, Cynthia M. Magro, Dana J. Lukin

ulcerative proctitis inflammatory bowel disease mesalamine oral corticosteroids erythematous skin lesions vesicles pustules neutrophilic dermatosis ustekinumab IL-12/23 inhibitor dapsone vesiculopustular eruption of IBD IBD ND UST

TLDR A woman with inflammatory bowel disease improved after treatment with ustekinumab for a rare skin condition associated with her disease.

In 2021, a 50-year-old woman with ulcerative proctitis, a form of inflammatory bowel disease (IBD), presented with bloody diarrhea, abdominal pain, and new skin and oral lesions. She had not responded to mesalamine treatment and was intolerant to oral corticosteroids. Upon hospitalization, she exhibited multiple erythematous skin lesions that evolved into vesicles and pustules, some with central ulceration and crusting. Laboratory tests indicated severe inflammation and anemia, while imaging and endoscopy confirmed colitis. Skin biopsy revealed neutrophilic dermatosis (ND), a rare skin condition associated with IBD. The patient was treated with ustekinumab (UST), an IL-12/23 inhibitor, and dapsone, leading to clinical and biochemical remission at 12-week follow-up. This case highlighted vesiculopustular eruption of IBD (VPE-IBD) as a differential diagnosis for skin eruptions in IBD patients and demonstrated the effectiveness of UST for VPE-IBD treatment, marking the first reported use of UST for this condition.

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