Coexistent pyoderma gangrenosum and tibialis anterior myositis as presenting manifestations of Crohn’s disease: case report and review of the literature

Abstract

Crohn's disease (CD) is a well defined inflammatory bowel disease. Patients primarily present with abdominal pain and diarrhea, however, extra-intestinal manifestations due to musculoskeletal and cutaneous involvement are seen in a varying range of patients. In this communication we describe a young woman who presented with a severe inflammatory illness that consequently developed into pyoderma gangrenosum, anterior tibialis myositis and arthritis that were all antecedent to the intestinal involvement. The patient favorably responded to infliximab with concomitant azathioprine therapy.

Systematic review: IBD-associated pyoderma gangrenosum in the biologic era, the response to therapy

“…Fifteen per cent of cases were reported to have inactive IBD based on the absence of symptoms with normal bloods with or without endoscopy, in the remaining 27%, IBD activity was not specified. Interestingly, in four cases, where IBD was initially believed to be inactive disease on the basis of absent bowel symptoms or disease activity not specified, subsequent endoscopic evidence of active IBD was found . In cases with peristomal PG ( n = 15), who had PG after colectomy for primarily colonic IBD, active disease was noted in four cases, whilst in a single case, there was no IBD activity.…”

“…Complete healing in 8 weeks was recorded in 13/18, while 2/18 had complete healing in 24 and 80 weeks. The remaining three did not specify time, but did have complete healing . Thus, in total, 29/34 (85%) cases healed with infliximab.…”

“…Ten required a second‐line therapy, with nine responding. Of the nine, six had infliximab . Of the other three, two required the addition of topical tacrolimus or mesalazine to oral steroids.…”

“…Interestingly, in four cases, where IBD was initially believed to be inactive disease on the basis of absent bowel symptoms or disease activity not specified, subsequent endoscopic evidence of active IBD was found. [16][17][18][19] In cases with peristomal PG (n = 15), who had PG after colectomy for primarily colonic IBD, active disease was noted in four cases, whilst in a single case, there was no IBD activity. However, in 10 cases this could not be determined from the data published.…”

“…Of the nine, six had infliximab. 14,17,[25][26][27][28] Of the other three, two required the addition of topical tacrolimus 11 or mesalazine 29 to oral steroids. The third had stoma closure after combination therapy of ciclosporin + mesalazine + topical steroids.…”