Ulcerative Colitis Presenting With Palmoplantar Neutrophilic Dermatosis

Abstract

A previously healthy 58-year-old woman presented with tender, pink papules and plaques over the palms (a) and soles, episcleritis, ankle edema, and bloody stools. She was afebrile, with a normal abdominal exam, and lab tests showed an elevated leukocyte count (13,300/µl), erythrocyte sedimentation rate (56 mm/h), and C-reactive protein (29.3 mg/L). Colonoscopy identified ulcerations in the rectosigmoid and sigmoid colon (b), and the biopsy revealed active colitis and crypt distortion (c; hematoxylin and eosin (H&E) ×10), consistent with ulcerative colitis. Palmar punch biopsy demonstrated nodular and diffuse neutrophilic infiltrate in the mid-to upper dermis (d; H&E ×10), consistent with neutrophilic dermatosis. Among the many extraintestinal manifestations of inflammatory bowel disease, palmoplantar neutrophilic dermatosis is a rare cutaneous complication.An 18-year-old man presented with intermittent colicky abdominal pain associated with vomiting and absolute constipation lasting for 2-3 days. He had experienced this two or three times in the previous year. He denied any weight loss, fever, taking of drugs, history of abdominal surgery, or peritoneal dialysis. Examination revealed only mild tenderness in the abdomen. Computed tomography showed a cluster of small bowel loops in the center of the abdomen within a thick membranous sac. These features probably represent a cocoon formation in the small bowel. Primary sclerosing encapsulating peritonitis is a rare benign condition.