When The Cart Is Before The Horses - Pyoderma Gangrenosum As Preceding Idiopathic Ulcerative Colitis: First Report in Gambia

Abstract

Chronic inflammatory bowel disease is characterized by a plethora of intestinal and extra-intestinal manifestations, and it is not difficult to establish its diagnosis when all the elements are present; however, when the extra-intestinal manifestations precede and are more severe than the intestinal symptoms themselves, then it becomes a diagnostic challenge, delaying treatment, affecting quality of life, and darkening its prognosis. We report a case with six-months onset of necrotic ulcerative lesions, compatible with severe pyoderma gangrenosum, as the first and only manifestation of the disease during first four months, with only and vague symptoms of intestinal manifestations such as abdominal pain, and diarrhea with phlegm and rarely with blood last two months. Diagnosis of ulcerative colitis was established through colonoscopy, with the biopsy being non-specific in the diagnosis of colitis. The response of the dermatological manifestations was spectacular to conventional therapy with steroids and salicylates.