Question of the Week # 181

181) A 35 year-old man with history of ulcerative colitis is seen in your office for nodular, tender skin lesions on both of his anterior legs. He was diagnosed with ulcerative colitis about 6 months ago when he first presented with severe bloody diarrhea. He was initially managed with steroids and is now, being maintained on Mesalamine. A colonoscopy at the time of diagnosis revealed pancolitis. He has no diarrhea now. There is no evidence of weight-loss.  Physical examination reveals tender erythematous lesions on the  anterior aspect of his bilateral lower extremities. Laboratory investigations reveal leucocytosis and elevated C-reactive protein. Which of the following is a poor prognostic factor in Inflammatory Bowel Disease?

A) Proctitis

B) Erythema nodosum

C) Albumin of 4.1 gm/dl

D) Lymphocytosis

E) Elevated ANCA (anti-neutrophilic cytoplasmic antibodies) level.

4 Responses

  1. D) Lymphocytosis is one of the poor prognosis factors in Inflammatory bowel disease.

  2. B
    Erythema nodosum is a BAD sign in IBD but GOOD sign in Scleroderma

  3. E:) ANCA associated with refractory UC, pouchitis.
    Extensive involvement is a poor prognosis factor in both diseases; conversely, isolated small bowel Crohn’s disease and ulcerative proctitis carry particularly good prognoses. A short clinical history, fistulae or abscesses at presentation probably represent an aggressive form of Crohn’s disease. Hypoalbuminemia, anemia and raised inflammatory markers are laboratory markers which suggest a worse prognosis in the short and possibly long-term.

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