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 Table of Contents  
IMAGES IN RHEUMATOLOGY
Year : 2018  |  Volume : 13  |  Issue : 2  |  Page : 131-132

Ulcerative colitis and systemic sclerosis


Consultant Gastroenterologist, Gleneagles Global Health City, Chennai, Tamil Nadu, India

Date of Web Publication24-May-2018

Correspondence Address:
Dr. Mayank Jain
804, Meridian Heights, Peters Road, Opposite New College, Royapettah, Chennai - 600 014, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injr.injr_141_17

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  Abstract 


Keywords: Colitis, gastrointestinal, scleroderma


How to cite this article:
Jain M. Ulcerative colitis and systemic sclerosis. Indian J Rheumatol 2018;13:131-2

How to cite this URL:
Jain M. Ulcerative colitis and systemic sclerosis. Indian J Rheumatol [serial online] 2018 [cited 2019 Dec 15];13:131-2. Available from: http://www.indianjrheumatol.com/text.asp?2018/13/2/131/228278



Manifestations of scleroderma in the gastrointestinal tract are common, occurring in 50%–90% of patients. They typically result from the fibrosis that characterizes the disease and result in substantial dysfunction in the processes of motility, digestion, absorption, and excretion.[1] Colonic involvement in scleroderma could result in delayed transit, telangiectasia, pseudodiverticulae, collagen deposition in the rectum leading to reduced rectal compliance and “Watermelon rectum' due to rectal vascular ectasias.[2],[3]

A 50-year-old female presented, for the first time in 2012, with tightness of skin over the extremities and face, generalized weakness, breathlessness on exertion, and loss of appetite for 6 months. She reported increased stool frequency for the past 5 months. The stools were small volume, containing blood and mucus, associated with urgency and crampy lower abdominal pain. On examination, she had features suggestive of diffuse systemic sclerosis-oral ulcers, perioral fibrosis, calcinosis, Raynaud's phenomenon, and sclerodactyly. Systemic examination revealed crackles at both lung bases.

Laboratory parameters were unremarkable. Extractable nuclear antibody testing showed Antinuclear antibody (ANA, 1+) and strongly positive anti-Scl70 (+++). Abdominal ultrasound was normal. HRCT chest showed changes of early interstitial lung disease bilaterally with mediastinal and bilateral perihilar lymphadenopathy. Two-dimensional echo showed Grade I diastolic dysfunction but no evidence of pulmonary arterial hypertension. Colonoscopy [Figure 1]a showed loss of vascularity, granularity, friability, pseudopolyp formation, and multiple ulcers till the sigmoid colon. Biopsy showed cryptitis, crypt abscesses, crypt distortion, and lymphocytic infiltration with ulcerated colonic mucosa. The patient was put on d-penicillamine, pyridoxine, nifedipine, antibiotics, mesalamine, folic acid, and aspirin. Corticosteroids were not started in the patient for the fear of infection. She followed up a month later and reported partial improvement in breathlessness and Raynaud's phenomenon. Her stool frequency had reduced to two times per day with no blood or mucus in stools. On regular telephonic follow-up, her symptoms had been under good control. At a recent hospital visit, 5 years later in December 2017, repeat sigmoidoscopy [Figure 1]b showed significant mucosal healing.
Figure 1: (a) - Colonoscopic picture at initial presentation (2012) (b) - Colonoscopic picture showing mucosal healing (2017)

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Ulcerative colitis with scleroderma is a very rare clinical association and has been described in only a handful of case reports in world literature [4],[5],[6],[7] On follow-up of one such case over a period of 30 years,[8] the authors concluded that though ulcerative colitis has several extraintestinal manifestations and immune-mediated injury, the association between scleroderma and ulcerative colitis appears to be primarily fortuitous.

The present case highlights this very rare association of ulcerative colitis and systemic sclerosis with good response to medical management. A long-term follow-up to determine the natural history of both diseases is required.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Forbes A, Marie I. Gastrointestinal complications: The most frequent internal complications of systemic sclerosis. Rheumatology (Oxford) 2009;48 Suppl 3:iii36-9.  Back to cited text no. 1
    
2.
Trezza M, Krogh K, Egekvist H, Bjerring P, Laurberg S. Bowel problems in patients with systemic sclerosis. Scand J Gastroenterol 1999;34:409-13.  Back to cited text no. 2
    
3.
Singh D, Shill M, Kaur H. The watermelon rectum. J Clin Gastroenterol 2001;33:164-6.  Back to cited text no. 3
    
4.
Bicks RO, Goldgraber MB, Kirsner JB. Generalized scleroderma associated with chronic ulcerative colitis. Am J Med 1958;24:447-53.  Back to cited text no. 4
    
5.
DeLuca VA Jr., Spiro HM, Thayer WR. Ulcerative colitis and scleroderma. Gastroenterology 1965;49:433-8.  Back to cited text no. 5
    
6.
Moncoucy X, Hamon R, Diebold MD, Coussinet S, Pennaforte JL, Thiéfin G, et al. Systemic sclerosis and ulcerative colitis. Gastroenterol Clin Biol 2001;25:324-5.  Back to cited text no. 6
    
7.
Toshihiko Y. A case of systemic sclerosis accompanied with ulcerative colitis. Nippon Daicho Komonbyo Gakkai 2009;62:471-4.  Back to cited text no. 7
    
8.
Turhal N, DeLuca VA Jr. Ulcerative colitis and scleroderma. A coincidental relationship? J Clin Gastroenterol 1994;18:218-9.  Back to cited text no. 8
    


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