Gastrointestinal: Severe inflammatory bowel disease-associated pyoderma gangrenosum

摘要

A 61-year-old man from the Dominican Republic with no past medical history presented to the Emergency Department with a left ankle wound that had failed to heal over several weeks (Figure la). He was admitted and given intravenous antibiotics for possible cellulitis. Routine laboratory testing showed iron deficiency anemia and a consultation by gastroenterology was requested. On further questioning, the patient denied abdominal pain, diarrhea and weight loss but did acknowledge sporadically bloody stools raising the possibility of inflammatory bowel disease (IBD) and pyoderma gangrenosum. His ankle wound was biopsied by dermatology; low power histologic sections showed focal epidermal erosions (Figure lb). Under high power, there was a diffuse, predominantly neutrophilic inflammatory infiltrate (Figure lc).