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Intestinal conditions were well-controlled&#46; Physical examination showed livedo racemosa with tender nodules involving the anterior and posterior aspects of both legs&#44; abdomen&#44; and forearms &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Laboratory data showed normal liver and renal function&#44; and urinalysis was normal&#46; Serum levels of C-reactive protein&#44; complements&#44; IgG&#44; and rheumatoid factor were all within normal ranges&#44; and antinuclear antibody&#44; antineutrophil cytoplasmic autoantibodies &#40;MPO-ANCA&#44; PR3-ANCA&#41;&#44; anticardiolipin&#44; and anti-&#946;2-glycoprotein 1 IgG antibody were all negative&#46; Cryoglobulin was not detected&#46; A biopsy specimen showed necrotizing vasculitis in the lower dermis without affecting neighboring tissues &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#41;&#46; Higher magnification revealed a crescent fibrinoid deposition in the vessel lumen infiltrated by neutrophils and lymphocytes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41;&#46; Perivascular inflammation was localized at the dermal-subcutis junction&#46; Elastica van Gieson stain revealed partially disrupted internal elastic lamina &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>c&#41;&#46; The patient was treated with low-dose prednisolone &#40;up to 30&#8239;mg&#47;day &#40;0&#46;6&#8239;mg&#47;kg&#41;&#41;&#44; sarpogrelate hydrochloride &#40;300&#8239;mg&#47;day&#41;&#44; and tocopherol nicotinate &#40;300&#8239;mg&#47;day&#41;&#59; however&#44; the numbness was resistant to therapy&#46; Mini-pulse therapy &#40;methylprednisolone 500&#8239;mg&#47;day for 3 consecutive days&#41; was effective for her numbness&#44; which&#44; however&#44; relapsed after the discontinuation of medication because of pregnancy&#46; Antiplatelet agents and vitamin E were re-started after delivery&#59; however&#44; she refused oral steroid therapy&#46; Her numbness still remains&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The presented case developed small-sized arteritis &#40;150&#8239;&#956;m in diameter&#41; at the dermo-subcutaneous junction&#46; Elastica van Gieson stain revealed the arteritis&#44; and vasculitis did not involve venous vessels&#46; ANCA was negative&#44; and detailed examination of the nose&#44; respiratory tract&#44; kidney and lung denied granulomatosis with polyangiitis and microscopic polyangiitis&#46; Several triggers such as viral infection and drugs&#44; or systemic diseases are occasionally associated with cPAN&#46; Leukocytoclastic vasculitis associated with IBD is suggested to be caused by circulating immune complex&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Only several cases of cPAN associated with IBD have been reported to date&#59; however&#44; as compared with Crohn&#8217;s disease&#44; cases of UC are rarely reported&#46; The reason why cases of UC are significantly fewer as compared with those of Crohn&#8217;s disease is currently unknown&#46; To our knowledge&#44; only five cases of UC have been reported to coexist with cPAN including the present case<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#8211;6</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The patients consisted of one male and four females&#46; All of the patients except one were diagnosed with UC prior to the onset of cPAN&#44; and the interval between the diagnoses of UC and cPAN varied between 10 months and 19 years&#46; Cutaneous manifestations presented with macular rash&#44; erythematous nodules&#44; and livedo racemosa&#46; Other systemic symptoms were arthritis&#47;arthralgia &#40;n&#8239;&#61;&#8239;3&#41;&#44; myalgia &#40;n&#8239;&#61;&#8239;2&#41;&#44; and peripheral neuropathy &#40;n&#8239;&#61;&#8239;1&#41;&#46; By contrast&#44; cPAN did not develop in parallel with worsening of intestinal conditions&#46; The patients were treated with methylprednisolone pulse therapy&#44; oral prednisolone&#44; immunosuppressant &#40;cyclophosphamide&#44; methotrexate&#44; azathioprine&#44; mycophenolate mofetil&#41;&#44; vasodilators&#44; and antiplatelet agents&#46; During the follow-up period&#44; one case relapsed&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In the present case&#44; we could follow our patient for over four years&#44; and her numbness did not perfectly disappear&#46; The shared pathogenesis of both disorders has been speculated such as abnormal immune response to some specific pathogen&#44; an immune complex etiology&#44; or hypercoagulable states&#59; however&#44; the precise mechanism remains uncertain because the number of reported cases of the association of cPAN and UC is limited&#46; Nevertheless&#44; it should be kept in mind that IBD is a rare systemic disease in patients with cPAN&#46; Moreover&#44; clinicians should become aware of cutaneous vasculitis in patients with IBD&#44; in addition to pyoderma gangrenosum or erythema nodosum&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PSL&#58; prednisolone&#44; CPA&#59; cyclophosphamide&#44; MTX&#59; methotrexate&#44; AZA azathioprine&#44; MMF&#59; mycophenolate mofetil&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age&#47;sex&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration between cPAN and UC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Arthralgia&#47;Arthritis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Peripheral neuropathy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#47;M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#65291;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#65291;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&#44; CPA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&#44; CPA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&#44; MTX&#44; AZA&#44; MMF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#65291;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&#44; vasodilators&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">present case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cases of coexistence with cPAN and UC&#46;</p>"
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                      "titulo" => "Vasculitis in patients with inflammatory bowel diseases&#58; a study of 32 patients and systematic review of the literature"
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                            4 => "S&#46; Carette"
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                      "doi" => "10.1016/j.semarthrit.2015.07.006"
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                        "tituloSerie" => "Semin Arthritis Rheum"
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                      "titulo" => "Skin manifestations of inflammatory bowel disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;L&#46; Huang"
                            1 => "S&#46; Chandra"
                            2 => "D&#46;Q&#46; Shih"
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                    0 => array:2 [
                      "doi" => "10.3389/fphys.2012.00013"
                      "Revista" => array:5 [
                        "tituloSerie" => "Front Physiol"
                        "fecha" => "2012"
                        "volumen" => "3"
                        "paginaInicial" => "13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22347192"
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                      "titulo" => "Cutaneous polyarteritis nodosa"
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                          "etal" => false
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                            0 => "J&#46; D&#237;az-P&#233;rez"
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                            2 => "J&#46;L&#46; D&#237;az-Ram&#243;n"
                            3 => "R&#46;K&#46; Winkelmann"
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                    0 => array:2 [
                      "doi" => "10.1016/j.sder.2007.02.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Cutan Med Surg"
                        "fecha" => "2007"
                        "volumen" => "26"
                        "paginaInicial" => "77"
                        "paginaFinal" => "86"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17544958"
                            "web" => "Medline"
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                      "titulo" => "Cutaneous polyarteritis nodosa and ulcerative colitis"
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                            0 => "G&#46; Chiu"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "1991"
                        "volumen" => "18"
                        "paginaInicial" => "769"
                        "paginaFinal" => "770"
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                      "titulo" => "A case of cutaneous polyarteritis nodosa associated with ulcerative colitis"
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                          "etal" => false
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                            0 => "Y&#46; Matsumura"
                            1 => "K&#46; Mizuno"
                            2 => "H&#46; Okamoto"
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                        "tituloSerie" => "Br J Dermatol"
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                          "etal" => false
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                            0 => "D&#46;M&#46; Volk"
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Case and Research Letters
Cutaneous Polyarteritis Nodosa in a Patient with Ulcerative Colitis
Poliarteritis nudosa cutánea en un paciente con colitis ulcerosa
T. Hiraiwa, T. Yamamoto
Corresponding author
toyamade@fmu.ac.jp

Corresponding author.
Departamento de Dermatología, Universidad de Medicina de Fukushima, Fukushima, Japan
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Several cutaneous manifestations are occasionally observed in patients with inflammatory bowel disease &#40;IBD&#41;&#59; however&#44; isolated cutaneous vasculitis is rare among those skin lesions&#46; Both cutaneous small-vessel vasculitis and cutaneous polyarteritis nodosa &#40;cPAN&#41; are uncommon skin manifestations of IBD&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We present herein a case of cPAN in a patient with ulcerative colitis &#40;UC&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 33-year-old woman visited the dermatology clinic complaining of erythemas with tenderness on the bilateral lower extremities with numbness&#44; which had appeared three months previously&#46; She had been suffering from UC &#40;pancolitis type&#41; for 2&#46;5 years&#44; and had been treated with mesalazine &#40;5-aminosalicylic acid&#41;&#46; Intestinal conditions were well-controlled&#46; Physical examination showed livedo racemosa with tender nodules involving the anterior and posterior aspects of both legs&#44; abdomen&#44; and forearms &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Laboratory data showed normal liver and renal function&#44; and urinalysis was normal&#46; Serum levels of C-reactive protein&#44; complements&#44; IgG&#44; and rheumatoid factor were all within normal ranges&#44; and antinuclear antibody&#44; antineutrophil cytoplasmic autoantibodies &#40;MPO-ANCA&#44; PR3-ANCA&#41;&#44; anticardiolipin&#44; and anti-&#946;2-glycoprotein 1 IgG antibody were all negative&#46; Cryoglobulin was not detected&#46; A biopsy specimen showed necrotizing vasculitis in the lower dermis without affecting neighboring tissues &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#41;&#46; Higher magnification revealed a crescent fibrinoid deposition in the vessel lumen infiltrated by neutrophils and lymphocytes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41;&#46; Perivascular inflammation was localized at the dermal-subcutis junction&#46; Elastica van Gieson stain revealed partially disrupted internal elastic lamina &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>c&#41;&#46; The patient was treated with low-dose prednisolone &#40;up to 30&#8239;mg&#47;day &#40;0&#46;6&#8239;mg&#47;kg&#41;&#41;&#44; sarpogrelate hydrochloride &#40;300&#8239;mg&#47;day&#41;&#44; and tocopherol nicotinate &#40;300&#8239;mg&#47;day&#41;&#59; however&#44; the numbness was resistant to therapy&#46; Mini-pulse therapy &#40;methylprednisolone 500&#8239;mg&#47;day for 3 consecutive days&#41; was effective for her numbness&#44; which&#44; however&#44; relapsed after the discontinuation of medication because of pregnancy&#46; Antiplatelet agents and vitamin E were re-started after delivery&#59; however&#44; she refused oral steroid therapy&#46; Her numbness still remains&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The presented case developed small-sized arteritis &#40;150&#8239;&#956;m in diameter&#41; at the dermo-subcutaneous junction&#46; Elastica van Gieson stain revealed the arteritis&#44; and vasculitis did not involve venous vessels&#46; ANCA was negative&#44; and detailed examination of the nose&#44; respiratory tract&#44; kidney and lung denied granulomatosis with polyangiitis and microscopic polyangiitis&#46; Several triggers such as viral infection and drugs&#44; or systemic diseases are occasionally associated with cPAN&#46; Leukocytoclastic vasculitis associated with IBD is suggested to be caused by circulating immune complex&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Only several cases of cPAN associated with IBD have been reported to date&#59; however&#44; as compared with Crohn&#8217;s disease&#44; cases of UC are rarely reported&#46; The reason why cases of UC are significantly fewer as compared with those of Crohn&#8217;s disease is currently unknown&#46; To our knowledge&#44; only five cases of UC have been reported to coexist with cPAN including the present case<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#8211;6</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The patients consisted of one male and four females&#46; All of the patients except one were diagnosed with UC prior to the onset of cPAN&#44; and the interval between the diagnoses of UC and cPAN varied between 10 months and 19 years&#46; Cutaneous manifestations presented with macular rash&#44; erythematous nodules&#44; and livedo racemosa&#46; Other systemic symptoms were arthritis&#47;arthralgia &#40;n&#8239;&#61;&#8239;3&#41;&#44; myalgia &#40;n&#8239;&#61;&#8239;2&#41;&#44; and peripheral neuropathy &#40;n&#8239;&#61;&#8239;1&#41;&#46; By contrast&#44; cPAN did not develop in parallel with worsening of intestinal conditions&#46; The patients were treated with methylprednisolone pulse therapy&#44; oral prednisolone&#44; immunosuppressant &#40;cyclophosphamide&#44; methotrexate&#44; azathioprine&#44; mycophenolate mofetil&#41;&#44; vasodilators&#44; and antiplatelet agents&#46; During the follow-up period&#44; one case relapsed&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In the present case&#44; we could follow our patient for over four years&#44; and her numbness did not perfectly disappear&#46; The shared pathogenesis of both disorders has been speculated such as abnormal immune response to some specific pathogen&#44; an immune complex etiology&#44; or hypercoagulable states&#59; however&#44; the precise mechanism remains uncertain because the number of reported cases of the association of cPAN and UC is limited&#46; Nevertheless&#44; it should be kept in mind that IBD is a rare systemic disease in patients with cPAN&#46; Moreover&#44; clinicians should become aware of cutaneous vasculitis in patients with IBD&#44; in addition to pyoderma gangrenosum or erythema nodosum&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">48&#47;M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#65291;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#65291;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&#44; CPA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">69&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&#44; CPA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&#44; MTX&#44; AZA&#44; MMF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#65291;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&#44; vasodilators&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">present case&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Vasculitis in patients with inflammatory bowel diseases&#58; a study of 32 patients and systematic review of the literature"
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                          "etal" => true
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                            0 => "A&#46; Sy"
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                            2 => "N&#46; Dehghan"
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                            4 => "S&#46; Carette"
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                      "doi" => "10.1016/j.semarthrit.2015.07.006"
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                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2016"
                        "volumen" => "45"
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                    0 => array:2 [
                      "titulo" => "Skin manifestations of inflammatory bowel disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;L&#46; Huang"
                            1 => "S&#46; Chandra"
                            2 => "D&#46;Q&#46; Shih"
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                    0 => array:2 [
                      "doi" => "10.3389/fphys.2012.00013"
                      "Revista" => array:5 [
                        "tituloSerie" => "Front Physiol"
                        "fecha" => "2012"
                        "volumen" => "3"
                        "paginaInicial" => "13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22347192"
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                    0 => array:2 [
                      "titulo" => "Cutaneous polyarteritis nodosa"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; D&#237;az-P&#233;rez"
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                            2 => "J&#46;L&#46; D&#237;az-Ram&#243;n"
                            3 => "R&#46;K&#46; Winkelmann"
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                    0 => array:2 [
                      "doi" => "10.1016/j.sder.2007.02.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Cutan Med Surg"
                        "fecha" => "2007"
                        "volumen" => "26"
                        "paginaInicial" => "77"
                        "paginaFinal" => "86"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17544958"
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                      "titulo" => "Cutaneous polyarteritis nodosa and ulcerative colitis"
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                            0 => "G&#46; Chiu"
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                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "1991"
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Article information
ISSN: 15782190
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
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