A diffuse pustular eruption associated with ulcerative colitis

Abstract

Two patients each with a two-year history of chronic ulcerative colitis developed, over a 24- to 48-hour period, painful pustules involving the skin and oral mucosa. The pustular eruption was associated with a severe exacerbation of the colitis. Culture of the lesions and of the blood failed to reveal an infectious cause for the eruption. Histologic study of a pustule in case 2 revealed suppurative folliculitis. The lesions subsided rapidly in case 1 when intravenous hydrocortisone and intravenous and intramuscular antibiotics were administered, and further resolution occurred after colectomy. A similar rapid resoultion of the pustules occurred in case 2 after initiation of treatment with intramuscular cortisone acetate and antibiotics and with colectomy. This pustular eruption may represent a variant of pyoderma gangrenosum.

Sterile neutrophilic folliculitis with perifollicular vasculopathy: a distinctive cutaneous reaction pattern reflecting systemic disease

“…Neutrophilrich folliculitis and/or a folliculocentric vasculopathy as a harbinger of underlying extracutaneous disease is not a widely accepted concept. This series, in concert with prior reports describing folliculitis in the setting of Behget's disease (6), mixed cryoglobuHnemia (II), and as the initial nidus of PG (2,12), provides testimony to the importance of this reaction pattern. There were 5 patients in whom the disease complex was represented by an acneiform eruption or palpable purpura accompanied by arthralgias and fever.…”

Neutrophilic pustulosis and ulcerative colitis

“…13 12,18,19 Several well documented cases consisting of a clearly described sterile neutrophilic pustular eruption, pyrexia, malaise and peripheral neutrophilia, triggered by an exacerbation of ulcerative colitis have been reported. 5,10,13,20 The clinical pictures presented in these cases and in our case satisfy the criteria for the diagnosis of Sweet's syndrome, but in several of the cases listed here the pustular lesions were not typical of those of Sweet's syndrome. 1 Our case shows a well documented pustular eruption that fits in the concept of ND, associated with an ulcerative colitis.…”

Pustular pyoderma gangrenosum

“…In both these cases the pustules did not progress to ulceration. 2 The pustules were described as being painful, as in both our patients, and occurred mainly on the extensor extremities and upper trunk during severe exacerbations of colitis and were associated with fever and arthralgia. Our first patient's pustular lesions were situated mainly on his upper trunk, legs and feet and appeared while his ulcerative colitis was quiescent.…”