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      Multiple extraintestinal manifestations in a patient with acute severe ulcerative colitis: a case report

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      https://www.riss.kr/link?id=A108400018

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      다국어 초록 (Multilingual Abstract)

      Patients with inflammatory bowel disease (IBD) are at risk for extraintestinal manifestations (EIM) over the course of their disease. As EIMs can involve nearly every organ, and strongly influence the quality of life, early recognition and adequate treatment are necessary to prevent severe morbidity and mortality in affected patients. Pyoderma gangrenosum is a highly severe and debilitating skin condition that occurs in 1% to 10% of ulcerative colitis (UC) patients. Thromboembolic events are also serious EIMs and usually present as deep vein thromboses in the legs or as pulmonary embolisms. A 19-year-old woman presented with bloody diarrhea lasting for 3 months and deep ulceration on the right foot. She was diagnosed with UC. The patient's skin lesions did not improve with intravenous corticosteroids and oral mesalazine. After she was started on infliximab, we observed rapid resolution of the skin lesions. She continued to complain of mild dyspnea while in the hospital. Computed tomography performed using the thromboembolism protocol revealed pulmonary thromboembolism and deep venous thrombosis. The patient underwent anticoagulant therapy with low-molecular-weight heparin, and her dyspnea gradually improved. Anticoagulation was continued with warfarin. It is rare for IBD patients to have multiple EIMs; however, this case demonstrates that multiple EIMs are a possible presentation in UC and underscores the importance of a meticulous clinical examination and adequate evaluation in the management of IBD patients presenting with EIMs.
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      Patients with inflammatory bowel disease (IBD) are at risk for extraintestinal manifestations (EIM) over the course of their disease. As EIMs can involve nearly every organ, and strongly influence the quality of life, early recognition and adequate tr...

      Patients with inflammatory bowel disease (IBD) are at risk for extraintestinal manifestations (EIM) over the course of their disease. As EIMs can involve nearly every organ, and strongly influence the quality of life, early recognition and adequate treatment are necessary to prevent severe morbidity and mortality in affected patients. Pyoderma gangrenosum is a highly severe and debilitating skin condition that occurs in 1% to 10% of ulcerative colitis (UC) patients. Thromboembolic events are also serious EIMs and usually present as deep vein thromboses in the legs or as pulmonary embolisms. A 19-year-old woman presented with bloody diarrhea lasting for 3 months and deep ulceration on the right foot. She was diagnosed with UC. The patient's skin lesions did not improve with intravenous corticosteroids and oral mesalazine. After she was started on infliximab, we observed rapid resolution of the skin lesions. She continued to complain of mild dyspnea while in the hospital. Computed tomography performed using the thromboembolism protocol revealed pulmonary thromboembolism and deep venous thrombosis. The patient underwent anticoagulant therapy with low-molecular-weight heparin, and her dyspnea gradually improved. Anticoagulation was continued with warfarin. It is rare for IBD patients to have multiple EIMs; however, this case demonstrates that multiple EIMs are a possible presentation in UC and underscores the importance of a meticulous clinical examination and adequate evaluation in the management of IBD patients presenting with EIMs.

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      참고문헌 (Reference)

      1 Solem CA, "Venous thromboembolism in inflammatory bowel disease" 99 : 97-101, 2004

      2 Grainge MJ, "Venous thromboembolism during active disease and remission in inflammatory bowel disease : a cohort study" 375 : 657-663, 2010

      3 Fumery M, "Thromboembolic events and cardiovascular mortality in inflammatory bowel diseases : a meta-analysis of observational studies" 8 : 469-479, 2014

      4 Bernstein CN, "The prevalence of extraintestinal diseases in inflammatory bowel disease : a population-based study" 96 : 1116-1122, 2001

      5 Hedin CR, "The pathogenesis of extraintestinal manifestations : implications for IBD research, diagnosis, and therapy" 13 : 541-554, 2019

      6 Bernstein CN, "The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease : a population-based cohort study" 85 : 430-434, 2001

      7 Harbord M, "The first European evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease" 10 : 239-254, 2016

      8 Hayashi H, "Successful treatment with infliximab for refractory pyoderma gangrenosum associated with inflammatory bowel disease" 39 : 576-578, 2012

      9 Nguyen GC, "Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients" 103 : 2272-2280, 2008

      10 Polcz M, "Pyoderma gangrenosum in inflammatory bowel disease : the experience at Mater Health Services’ Adult Hospital 1998-2009" 5 : 148-151, 2011

      1 Solem CA, "Venous thromboembolism in inflammatory bowel disease" 99 : 97-101, 2004

      2 Grainge MJ, "Venous thromboembolism during active disease and remission in inflammatory bowel disease : a cohort study" 375 : 657-663, 2010

      3 Fumery M, "Thromboembolic events and cardiovascular mortality in inflammatory bowel diseases : a meta-analysis of observational studies" 8 : 469-479, 2014

      4 Bernstein CN, "The prevalence of extraintestinal diseases in inflammatory bowel disease : a population-based study" 96 : 1116-1122, 2001

      5 Hedin CR, "The pathogenesis of extraintestinal manifestations : implications for IBD research, diagnosis, and therapy" 13 : 541-554, 2019

      6 Bernstein CN, "The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease : a population-based cohort study" 85 : 430-434, 2001

      7 Harbord M, "The first European evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease" 10 : 239-254, 2016

      8 Hayashi H, "Successful treatment with infliximab for refractory pyoderma gangrenosum associated with inflammatory bowel disease" 39 : 576-578, 2012

      9 Nguyen GC, "Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients" 103 : 2272-2280, 2008

      10 Polcz M, "Pyoderma gangrenosum in inflammatory bowel disease : the experience at Mater Health Services’ Adult Hospital 1998-2009" 5 : 148-151, 2011

      11 Aghazadeh R, "Inflammatory bowel disease in Iran : a review of 457 cases" 20 : 1691-1695, 2005

      12 Zezos P, "Inflammatory bowel disease and thromboembolism" 20 : 13863-13878, 2014

      13 Vavricka SR, "Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort" 106 : 110-119, 2011

      14 Vavricka SR, "Extraintestinal manifestations of inflammatory bowel disease" 21 : 1982-1992, 2015

      15 Jose FA, "Extraintestinal manifestations of inflammatory bowel disease" 46 : 124-133, 2008

      16 Greuter T, "Extraintestinal manifestations in inflammatory bowel disease : epidemiology, genetics, and pathogenesis" 13 : 307-317, 2019

      17 Monsen U, "Extracolonic diagnoses in ulcerative colitis : an epidemiological study" 85 : 711-716, 1990

      18 Lebwohl M, "Cutaneous manifestations of inflammatory bowel disease" 4 : 142-148, 1998

      19 Papay P, "Clinical presentation of venous thromboembolism in inflammatory bowel disease" 7 : 723-729, 2013

      20 K Arivarasan ; Vaishali Bhardwaj ; Sukrit Sud ; Sanjeev Sachdeva ; Amarender Singh Puri, "Biologics for the treatment of pyoderma gangrenosum in ulcerative colitis" 대한장연구학회 14 (14): 365-368, 2016

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