Wargo Jeffrey J, Adams Megan, Trevino Julian
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Department of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
BMJ Case Rep. 2017 Jan 30;2017:bcr2016218123. doi: 10.1136/bcr-2016-218123.
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.
一名56岁男性，有溃疡性结肠炎（UC）病史，接受次全结肠切除术后，因发热、干咳、眼红及新出现的血性、黏液性直肠分泌物入院。入院前2个月，皮肤科医生因角层下脓疱性皮肤病开始让他服用氨苯砜，但未意识到他最近自行停用了美沙拉嗪灌肠剂，从而诱发了UC发作。经过全面的住院评估，包括乙状结肠镜检查，确定累及直肠残端的活动性UC是导致其皮肤和眼科症状的原因。通过重新使用美沙拉嗪灌肠剂，实现了对UC的控制，其炎症性肠病（IBD）的肠外表现也得到缓解。该病例说明了仔细询问病史以及早期识别IBD肠外表现对于合理确定治疗靶点和预防不必要的发病的重要性。
