|IMAGES IN RHEUMATOLOGY
|Year : 2018 | Volume
| Issue : 2 | Page : 131-132
Ulcerative colitis and systemic sclerosis
Consultant Gastroenterologist, Gleneagles Global Health City, Chennai, Tamil Nadu, India
|Date of Web Publication||24-May-2018|
Dr. Mayank Jain
804, Meridian Heights, Peters Road, Opposite New College, Royapettah, Chennai - 600 014, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Keywords: Colitis, gastrointestinal, scleroderma
|How to cite this article:|
Jain M. Ulcerative colitis and systemic sclerosis. Indian J Rheumatol 2018;13:131-2
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. 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.,
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)|
Click here to view
Ulcerative colitis with scleroderma is a very rare clinical association and has been described in only a handful of case reports in world literature ,,, On follow-up of one such case over a period of 30 years, 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
Conflicts of interest
There are no conflicts of interest.
| References|| |
Forbes A, Marie I. Gastrointestinal complications: The most frequent internal complications of systemic sclerosis. Rheumatology (Oxford) 2009;48 Suppl 3:iii36-9.
Trezza M, Krogh K, Egekvist H, Bjerring P, Laurberg S. Bowel problems in patients with systemic sclerosis. Scand J Gastroenterol 1999;34:409-13.
Singh D, Shill M, Kaur H. The watermelon rectum. J Clin Gastroenterol 2001;33:164-6.
Bicks RO, Goldgraber MB, Kirsner JB. Generalized scleroderma associated with chronic ulcerative colitis. Am J Med 1958;24:447-53.
DeLuca VA Jr., Spiro HM, Thayer WR. Ulcerative colitis and scleroderma. Gastroenterology 1965;49:433-8.
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.
Toshihiko Y. A case of systemic sclerosis accompanied with ulcerative colitis. Nippon Daicho Komonbyo Gakkai 2009;62:471-4.
Turhal N, DeLuca VA Jr. Ulcerative colitis and scleroderma. A coincidental relationship? J Clin Gastroenterol 1994;18:218-9.