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Subcorneal pustular dermatosis and episcleritis associated with poorly controlled ulcerative colitis
  1. Jeffrey J Wargo1,
  2. Megan Adams2,
  3. Julian Trevino3
  1. 1Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2Department of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
  3. 3Department of Dermatology, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
  1. Correspondence to Dr Jeffrey J Wargo, jwarg75{at}


A man aged 56 years with a history of ulcerative colitis (UC) status postsubtotal colectomy was hospitalised with fevers, dry cough, eye redness and a new bloody, mucoid rectal discharge. 2 months prior to admission, the dermatologist had started him on dapsone for subcorneal pustular dermatosis but did not recognise that he had recently self-discontinued mesalamine enemas, inducing a flare of his UC. After a thorough inpatient evaluation, including flexible sigmoidoscopy, active UC involving the rectal stump was determined to be driving his dermatological and ophthalmological findings. By reinstituting mesalamine enemas, control of his UC was achieved and the extraintestinal manifestations of his inflammatory bowel disease (IBD) resolved. This case illustrates the importance of careful history taking and of early recognition of extraintestinal manifestations of IBD in order to appropriately target treatment and prevent unnecessary morbidity.

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  • Contributors JJW provided clinical care to the patient. JJW, MA and JT wrote the report each making significant contributions to structure, grammar, punctuation and educational content within their respective specialty. All authors have seen and approved the final version. JJW accepts responsibility for the overall content as a guarantor.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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