title: Leucocytoclastic vasculitis in severe ulcerative colitis.
abstract: Ulcerative colitis may be associated with a number of extraintestinal skin manifestations including erythema nodosum and pyoderma gangrenosum. We describe an unusual case of a 26-year-old military pilot with ulcerative colitis and skin lesions diagnosed as leucocytoclastic vasculitis. The skin lesions occurred twice during the severe flare. The first occurrence was treated successfully with corticosteroids. When the lesions recurred several weeks later, concomitant with the ongoing flare, treatment with mesalamine and infliximab resolved the lesions. Ultimately, the patient required total colectomy for flare unresponsive to maximum medical therapy. The leucocytoclastic vasculitis did not recur after colectomy. We propose a potential immunopathophysiologic mechanism linking the 2 conditions based on recent biochemical and clinical research.
authors.affiliation: Department of Internal Medicine, 48 MDOS/SGOMI, Unit 5210 Box 320, RAF Lakenheath, Brandon, Suffolk IP27 9PN, United Kingdom.
authors.forename: Donald
authors.initials: D
authors.lastname: Martin
authors.forename: Tristan
authors.initials: T
authors.lastname: Handler
authors.forename: Joseph
authors.initials: J
authors.lastname: McDermott
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000601:surgery; D003879:Dermatologic Agents / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008889:Military Personnel; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D019804:Mesalamine; D000069285:Infliximab