# Pyoderma Gangrenosum as the First Manifestation of Inflammatory Bowel Disease: A Case Report

## TL;DR

A young man with pyoderma gangrenosum was later diagnosed with inflammatory bowel disease, showing that this skin condition can be an early sign of the disease.

## Contribution

This case report highlights pyoderma gangrenosum as a rare initial manifestation of IBD in a patient without gastrointestinal symptoms.

## Key findings

- Pyoderma gangrenosum was unresponsive to conventional treatments but resolved after IBD diagnosis and infliximab therapy.
- Colonoscopy and histopathology confirmed chronic ulcerative colitis despite absence of gut symptoms.
- The case suggests pyoderma gangrenosum can precede IBD diagnosis in rare instances.

## Abstract

Approximately 50% of patients with inflammatory bowel disease (IBD) exhibit extraintestinal manifestations, among which skin and mucosal lesions are common. However, pyoderma gangrenosum occurs in only 1%‐2% of IBD patients. We report the case of a 23‐year‐old male patient who was admitted to the hospital with pyoderma gangrenosum that was unresponsive to conventional treatments. The patient did not exhibit any gastrointestinal symptoms. We conducted diagnostic investigations, excluding causes such as infections, vascular occlusions, and systemic diseases. The patient did not respond to systemic antibiotic therapy and local care. With mild thickening of the colon wall observed on a CT scan, we decided to perform a colonoscopy, which revealed lesions suggestive of chronic ulcerative colitis. Histopathological examination of the colon tissue confirmed the diagnosis. With the diagnosis of early onset chronic ulcerative colitis presenting with extraintestinal manifestations, we decided to treat the patient with the biological drug infliximab. After 3 months of treatment, the pyoderma gangrenosum lesions healed. In summary, this clinical case indicates that pyoderma gangrenosum can be an initial and rare manifestation of IBD.