Curriculum for Specialty Certificate Examination in Gastroenterology

Countdown to the Examination

Friday, 7 March 2014

Question

50 yrs old female with quiescent CD present to A&E with acute febrile illness following annual vaccination. She C/O fever, malise, headache, mouth ulcers and athralgia. the doctors notced multiple erythematous tender papules in the hand and immunisation site.


 investigations:
Hb      156
WCC 16
Plt      366
Alb    35
CRP   70
c-ANCA -ve
p-ANCA weak +ve

What is the most likely diagnosis?
1- Dermatitis herpetiform
2- Erythema nodosum
3- Mycobacterium tuberclosis
4- Pyoderma gangrinosum
5- Sweet's syndrome

Sweet's syndrome is an acute febrile neutrophilic dermatostis associated with IBD.
Pathergy at immunisation site.
Patient usually has raised WCC,ESR,CRP and p-ANCA present
Skin biopsy: diffuse neutrophil infiltrate in the upper dermis
Treatment with topical/ oral steroids

1 comment:





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