title: [Extra-intestinal manifestations and complications in chronic active ulcerative colitis in childhood and adolescence].
abstract: METHODS
  A 18-year-old girl suffered from chronic active ulcerative colitis for ten years with growth retardation, primary amenorrhoea and osteopenia, so that total colectomy had been discussed as a possible treatment option. However, clinical remission was reached using a medication with budesonide (9 mg), mesalazine (3 g) and azathioprine (100 mg) when a painful ulcer occurred at the right lower leg.
  
  
  METHODS
  The clinical examination revealed an ulcer of 7 cm diameter with a red-bluish margin at the right lower leg. The typical clinical features led to the diagnosis of pyoderma gangrenosum.
  
  
  METHODS
  High doses of orally administered prednisolone induced the healing of the pyoderma gangrenosum within 2 months. After another 2 months systemic steroids were discontinued. Further laboratory tests confirmed secondary adrenal and ovarian failure (negative CRH-GnRH-test). Change of drug therapy to hydrocortisone (25 mg) in combination with mesalazine (3 g) and azathioprine (100 mg) improved the clinical course. Hydrocortisone was gradually reduced until CRH-GnRH-response returned to normal.
  
  
  CONCLUSIONS
  Drug therapy with azathioprine can be regarded as a treatment option in pediatric patients with chronic active inflammatory bowel disease. It can be concluded from this case report that faced with controversial therapeutic options in adolescent patients the decision mainly depends on the clinical experience of the physician than on the results of controlled clinical trials.
authors.affiliation: Abt. für Gastroenterologie und Hepatologie, Internistische Gemeinschaftspraxis, Herne. Dietrich.Hueppe@ruhr-internisten.de
authors.forename: D
authors.initials: D
authors.lastname: Hüppe
authors.forename: B
authors.initials: B
authors.lastname: Schenck
authors.forename: A
authors.initials: A
authors.lastname: Tromm
mesh_terms: D000293:Adolescent; D001379:Azathioprine / Q000008:administration & dosage / Q000009:adverse effects; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007871:Leg Ulcer / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D019804:Mesalamine / Q000008:administration & dosage / Q000009:adverse effects; D011239:Prednisolone / Q000008:administration & dosage; D017511:Pyoderma Gangrenosum / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D019804:Mesalamine; D019819:Budesonide; D011239:Prednisolone; D001379:Azathioprine; D006854:Hydrocortisone
vernacular_title: Extraintestinale Manifestationen und Komplikationen bei chronisch aktivem Verlauf der Colitis ulcerosa im Kindes- und Jugendalter.