Ulcerative colitis presenting as leukocytoclastic vasculitis of skin

Abstract

A number of cutaneous changes are known to occur in the course of inflammatory bowel diseases (IBD), including pyoderma gangrenosum, erythema nodosum, perianal disease, erythematous eruptions, urticaria, and purpura. However, occurrence of skin manifestations prior to the development of ulcerative colitis is a rare occasion. Here, we report a case of ulcerative colitis associated with leukocytoclastic vasculitis in which the intestinal symptoms became overt 8 mo after the development of skin lesions.

Figure 1

Skin biopsy specimen (HE, × 200) showing polymor-phonuclear cells and lymphocyte infiltration in and around the vessels of dermis beneath the multilayered keratinized squamous epithelium with some nuclear debris in the interstitium (A) and fibrin deposits in the vessel wall and nuclear debris (B).

Figure 2

Magnetic resonance cholangiopancreaticography demonstrating ductal irregularities and beading appearence in the distal branches of the right and left hepatic canals.