A 46-year-old woman with personal hypothyroidism after Graves-Basedow disease, rheumatoid arthritis and UC refractory to treatment. She had a history of peritoneal drainage and anti-TNF, other complications associated with anal abscess node
Controlled by the Unit of Illness recommends surgical treatment refractory to treatment, maintaining evident lesions endoscopic and histological, together with significant affectation of their general condition and
Given the perianal disease, pancoloproctectomy and terminal ileostomy were performed in the right iliac fossa.
Pathology of the surgical specimen confirmed the diagnosis of UC.
Postoperative evolution is slow, with urinary tract infection and paralytic ileus requiring nasogastric tube placement.
Prior to the surgical treatment, the treatment with thiopurines and anti-TNF had been withdrawn, and during hospitalization, a regimen of withdrawal of oral corticosteroids was started until complete suspension.
She was discharged, asymptomatic, 35 days after surgery.
Seven days later, the patient came to the stomatherapy service because of an ulceration of anfractuous edges and a subcutaneous abscess near the stoma, which gives rise to intense pain and difficulty in applying the collecting device.
On physical examination, a deep ulceration of irregular and indurated edges, extremely painful, affecting a large part of the left and inferior margin of the stoma was observed. In close proximity, there was a small erythematous collection of purulent bridging.
With the diagnosis of PGP was decided admission for treatment and monitoring evolution.
Samples were taken for culture and histological study; no abnormal germ was found and the pathological study was informed of nonspecific inflammation.
Tacrolimus was administered topically in 0.3 % solution, daily application; adalimumab: an induction dose of 80 mg and then 40 mg subcutaneous every two weeks, maintenance regimen; methylprednisolone 32 mg oral descending regimen:
In addition to the general treatment, local cures were carried out by the Stomatherapy Service, applying a transparent absorbent dressing (carboxy-acyl hydrocolloid unit carrying out daily changes and topical polyurethane film), which tacrolimus
The clinical course was very satisfactory with complete resolution of the pyoderma after eight weeks of treatment.
Follow-up continued in outpatient clinics and ten months later the lesions progressed and the patient did not need maintenance medical treatment.
