Myositis as an Initial Presentation of Ulcerative Colitis before Gastrointestinal Symptoms

Abstract

The musculoskeletal system can be involved as an extra-intestinal manifestation of inflammatory bowel disease. Among these, myositis in ulcerative colitis (UC) is very rare. A 14-year-old girl was admitted due to severe shoulder tenderness. She had complained of left jaw pain and swelling for the past 10 days. Inflammatory markers were elevated with no evidence of infectious etiology. Myositis was suspected by shoulder magnetic resonance imaging. Three days after admission, she developed hematochezia. Muscle biopsy and colonoscopy was performed due to worsening left mandibular area pain and persistent hematochezia. Colonoscopy showed consistent findings with UC. She was finally diagnosed with UC with myositis as an extra-intestinal manifestation. She showed a dramatic response to UC treatment. Gastrointestinal symptoms were well-controlled. After 14 months, UC symptoms and muscle pain were aggravated, which were relieved after steroid and cyclosporin treatment. We report a unique case of UC initially presented with myositis, preceding gastrointestinal symptoms.

Myositis as a de-novo extraintestinal manifestation of ulcerative colitis in a pediatric patient developing post-colectomy: a case report

“…All three patients developed myositis simultaneously with the diagnosis of UC, and only in our case did the patient develop myositis 1 year after the initial UC diagnosis. [5][6][7] The diagnosis of myositis should be considered in all patients with IBD who complain of myalgia, muscle weakness, and edema, as these were the most commonly encountered symptoms in the described patients. A muscle biopsy is the most important step in the diagnostic process of myositis, and it is essential to distinguish between the various subtypes of this disease.…”

Myositis as an Extraintestinal Manifestation of Ulcerative Colitis: A Case Report and Literature Review

“…The patient was managed with steroids, mesalamine, and azathioprine. Cyclosporine and intravenous immunoglobulin (IVIG) were added for steroid-resistant pyoderma gangrenosum [ 1 ].…”

“…Finally, some authors have thought that therapy for IBD, including glucocorticoids or azathioprine, may be responsible for muscle injury. However, in this circumstance, inflammatory myopathy could be differentiated from steroid myopathy through a muscle biopsy [1][2][3][4][5][6].…”

“…Leukocyte recruitment is upregulated due to an increase of the chemoattractant CXCL8 and mucosal vascular addressin cell adhesion molecule 1 (MadCAM1), which causes leukocyte adhesion and extravasation into the mucosal tissue. Although the pathogenesis is not fully understood, the development of UC could be attributed to an imbalance between enteric microflora in mucosal immunity, causing the individual to respond to nonpathogenic bacteria found in their intestines [1][2][3][4][5].…”

Keep an Eye Out for Crohn’s Disease: Orbital Myositis as the Initial Sign before Gastrointestinal Manifestations

“…Ocular manifestations usually occur in 0.3-5% of all IBD patients, the most common being episcleritis, scleritis and uveitis. OM is a very rare EIM of IBD and its presentation prior to the development of gastrointestinal manifestation is unusual, with only a few cases reported in the literature [2] . It manifests as inflammation of either one or more extraocular muscles and usually presents with mass effects related to the inflammatory process, leading to proptosis, diplopia, orbital swelling, injection and ophthalmoplegia [3] .…”