Pyoderma gangrenosum as a clinical debut of Crohn's disease (clinical case)

Background. Crohn's disease is a chronic relapsing disease of the gastrointestinal tract of unclear etiology, characterized by transmural, segmental, granulomatous inflammation with the development of local and systemic complications. Currently, early diagnosis of Crohn's disease remains a challenge. In some cases, several years pass from the moment the first symptoms appear to the diagnosis. The recognition of nosology is difficult due to the variety of clinical manifestations due to the involvement of several sections of the gastrointestinal tract in the pathological process at the same time, as well as the addition of extraintestinal manifestations that can be considered as independent nosological forms. One of the most severe skin lesions in Crohn's disease is pyodermagangrenosum – progressive skin necrosis that occurs against the background of systemic pathology and is characterized by the formation of deep ulcers with purulent-necrotic discharge, often associated with diseases of the internal organs.

Objective. The aim of the work is to analyze a diagnostically complex clinical case from real medical practice, when Crohn's disease was detected after the onset of pyodermagangrenosum.

Materials and methods. The article describes a clinical case with Crohn's disease and pyodermagangrenosum, which is an extraintestinal symptom associated with the activity of inflammatory bowel disease. A feature of this case is the onset of the disease with skin lesions against the background of the absence of pathognomonic gastrointestinal symptoms at the onset of the disease. To establish the diagnosis, the patient underwent a comprehensive examination, including laboratory and endoscopic (esophagogastroduodenoscopy, colonoscopy with examination of the terminal ileum), diagnostics, X-ray examination (tubeless enterography) and morphological verification (biopsy of the skin and intestines).

Conclusion. Our clinical observation shows the importance of careful history taking (episodes of recurring abdominal pain, intermittent diarrhea) and the need for timely examination of the intestine in unclear cases. The clinical case also demonstrates the importance of a multidisciplinary approach and continuity between doctors of various specialties in the diagnosis of Crohn's disease. Timely diagnosis of this disease and adequate treatment make it possible to achieve clinical, endoscopic and histological remission, avoid complications, maintain patients' ability to work and improve the quality of life of patients.

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