Crohn's Disease Complicated by Pyoderma Gangrenosum, Report of a Case

A 37-year-old female with Crohn's disease was admitted to our institution. At the age of 32 years, she was initially diagnosed as having Crohn's disease of colitis type complicated by pyoderma gangrenosum, and was later operated on because of perforation of the sigmoid colon. Six months after the surgery, she was again admitted, because of recurrence of pyoderma gangrenosum. At the time of admission, there were active lesions at the anastomosis of the colon. The pyoderma immediately responded to prednisolone and her intestinal lesions were treated by total parenteral nutrition. However, the pyoderma gangrenosum later reoccurred when her Crohn's disease progressed to colo-ileal and colo-uteral fistulas which necessitated surgery. Of interest is the fact that the cutaneous lesions did not reoccur when her Crohn's disease developed in ileo-cutaneous fistulas. Our case suggests a close association between pyoderma gangrenosum and severe inflammation of the colon in Crohn's disease.