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Case Reports
. 2019 Sep 30;30(3):190-193.
doi: 10.31138/mjr.30.3.190. eCollection 2019 Sep.

A 40-Year-Old Woman with Asymmetric Arthritis and Skin Lesions

Konstantina A Bounia  1 , Georgia M Konstantopoulou  1 , Stamatis-Nick C Liossis  1   2
Affiliations
Case Reports

A 40-Year-Old Woman with Asymmetric Arthritis and Skin Lesions

Konstantina A Bounia et al. Mediterr J Rheumatol. .

Abstract

A 40-year old woman with recent asymmetric arthritis and fever was evaluated in our clinic. NSAIDs were recommended, but a few days later she was admitted to our hospital because of worsening arthritis along with the appearance of new skin lesions in both feet. Although she was treated with antibiotics and high dosages of steroids, her arthritis did not improve. The skin lesions progressed from bullous initially to ulcerative pyoderma gangrenosum, so we suggested endoscopic examination of the colon which revealed Crohn's disease. The patient received I.V. treatment with infliximab resulting in a remarkable response. Some patients with Crohn's disease may present with extraintestinal manifestations well before the bowel disease is manifested and diagnosed.

Keywords: Crohn’s Disease; arthritis; pyoderma gangrenosum.

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Figures

Figure 1.
Figure 1.
Painful nodules of the feet and right ankle.
Figure 2.
Figure 2.
X-rays of the feet during hospital admission showing enthesitis (blue arrows) on both calcanei (film B and C). In contrast, 3 months before she referred to our clinic there is no sign of enthesis involvement (film A).
Figure 3.
Figure 3.
Skin lesions greatly improved after two infusions of Infliximab.
Figure 4.
Figure 4.
Great improvement of complete blood count and acute phase reactants of the patient a couple of months after treatment with infliximab.
See this image and copyright information in PMC

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