Leucocytoclastic vasculitis in severe ulcerative colitis

Abstract

Ulcerative colitis may be associated with a number of extraintestinal skin manifestations including erythema nodosum and pyoderma gangrenosum. We describe an unusual case of a 26-year-old military pilot with ulcerative colitis and skin lesions diagnosed as leucocytoclastic vasculitis. The skin lesions occurred twice during the severe flare. The fi rst occurrence was treated successfully with corticosteroids. When the lesions recurred several weeks later, concomitant with the ongoing fl are, treatment with mesalamine and infl iximab resolved the lesions. Ultimately, the patient required total colectomy for fl are unresponsive to maximum medical therapy. The leucocytoclastic vasculitis did not recur after colectomy. We propose a potential immunopathophysiologic mechanism linking the 2 conditions based on recent biochemical and clinical research. © Association of Military Surgeonsof the U.S.