[Sweet syndrome and erythema nodosum in ulcerative colitis, refractory to steroids: successful treatment with tacrolimus].
BACKGROUND
Inflammatory bowel disease is accompanied by cutaneous manifestations in about 10% of cases. Erythema nodosum and pyoderma gangraenosum are most frequently observed, which often subside on treatment of the underlying disease.


METHODS
A 30-year-old male with a history of long-standing ulcerative colitis experienced an acute attack despite treatment with azathioprine. Further he noticed dull red, elevated and tender maculae on the forelegs. A disseminated and papulosquamous exanthema arose on the back of the trunk and the upper extremities without pruritus. Well-being was compromised and blood sampling revealed an inflammatory response. High-dose steroids with antibiotics were without benefit until they were combined with tacrolimus, an immunosuppressive agent acting similar to ciclosporin. Remission occurred rapidly and the skin lesions resolved. Six months later the patient is currently still in remission and developed no signs of recurrent exanthema.


CONCLUSIONS
The cutaneous lesions are thought to be related to ulcerative colitis and were classified as erythema nodosum and Sweet syndrome. This is the first report on the successful use of tacrolimus in steroid-refractory ulcerative colitis with extraintestinal cutaneous involvement.
Medizinische Klinik I, Bereich Gastroenterologie, Universitätsklinikum Lübeck. klaus.fellermann@medinf.mu-luebeck.de
K
K
Fellermann
B
B
Rudolph
T
T
Witthöft
K R
KR
Herrlinger
M
M
Tronnier
D
D
Ludwig
E F
EF
Stange
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D004893:Erythema Nodosum / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D013256:Steroids; D016463:Sweet Syndrome / Q000209:etiology*; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D013256:Steroids; D016559:Tacrolimus