title: Subcorneal pustular dermatosis and episcleritis associated with poorly controlled ulcerative colitis.
abstract: A man aged 56 years with a history of ulcerative colitis (UC) status postsubtotal colectomy was hospitalised with fevers, dry cough, eye redness and a new bloody, mucoid rectal discharge. 2 months prior to admission, the dermatologist had started him on dapsone for subcorneal pustular dermatosis but did not recognise that he had recently self-discontinued mesalamine enemas, inducing a flare of his UC. After a thorough inpatient evaluation, including flexible sigmoidoscopy, active UC involving the rectal stump was determined to be driving his dermatological and ophthalmological findings. By reinstituting mesalamine enemas, control of his UC was achieved and the extraintestinal manifestations of his inflammatory bowel disease (IBD) resolved. This case illustrates the importance of careful history taking and of early recognition of extraintestinal manifestations of IBD in order to appropriately target treatment and prevent unnecessary morbidity.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Jeffrey J
authors.identifier: http://orcid.org/0000-0003-0365-8994
authors.initials: JJ
authors.lastname: Wargo
authors.affiliation: Department of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Adams
authors.affiliation: Department of Dermatology, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA.
authors.forename: Julian
authors.initials: J
authors.lastname: Trevino
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D018450:Disease Progression; D004733:Enema; D006801:Humans; D008297:Male; D055118:Medication Adherence; D019804:Mesalamine / Q000627:therapeutic use*; D008875:Middle Aged; D012007:Rectum; D015423:Scleritis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012812:Sigmoidoscopy; D012872:Skin Diseases, Vesiculobullous / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine