When The Cart Is Before The Horses - Pyoderma Gangrenosum As Preceding Idiopathic Ulcerative Colitis: First Report in Gambia
Asmell Ramos Cabrera, Hector Oscar Victoria Barzaga, Kehinde O Oduntan, Mayelin Martinez, Amie Jones, Jennifer Shallop
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
