# Hidden in Plain Sight: A Case Series of Inflammatory Bowel Disease With Dermatologic Lesions As Initial or Concurrent Manifestations

## TL;DR

This paper presents three cases where skin symptoms like pyoderma gangrenosum and erythema nodosum were early signs of newly diagnosed inflammatory bowel disease.

## Contribution

The novelty lies in highlighting dermatologic lesions as initial or concurrent manifestations of IBD, emphasizing the need for thorough clinical evaluation.

## Key findings

- Three patients with newly diagnosed IBD presented with skin lesions at the time of diagnosis.
- Dermatopathology confirmed pyoderma gangrenosum and erythema nodosum alongside ulcerative colitis.
- Treatment with steroids and biological agents led to clinical improvement.

## Abstract

Pyoderma gangrenosum (PG) and erythema nodosum (EN) are rare skin conditions associated with inflammatory bowel disease (IBD), with increasing incidence as the disease progresses. We describe three cases of newly diagnosed IBD with cutaneous extraintestinal manifestations (EIMs) at the time of diagnosis. Three previously healthy patients presented with bloody diarrhea and concomitant nodular and ulcerating skin lesions at the onset of diarrhea. Dermatopathology showed PG and EN with endoscopic confirmation of ulcerative colitis. Clinical improvement was achieved with steroids and biological agents. These cases display the importance of a proper review of symptoms and a detailed workup of dermatological lesions prior to assuming infectious etiology.