Question of the Week # 181

181) A 35 year-old man with history of ulcerative colitis is seen in your office for nodular, tender skin lesions on both of his anterior legs. He was diagnosed with ulcerative colitis about 6 months ago when he first presented with severe bloody diarrhea. He was initially managed with steroids and is now, being maintained on Mesalamine. A colonoscopy at the time of diagnosis revealed pancolitis. He has no diarrhea now. There is no evidence of weight-loss.  Physical examination reveals tender erythematous lesions on the  anterior aspect of his bilateral lower extremities. Laboratory investigations reveal leucocytosis and elevated C-reactive protein. Which of the following is a poor prognostic factor in Inflammatory Bowel Disease?

A) Proctitis

B) Erythema nodosum

C) Albumin of 4.1 gm/dl

D) Lymphocytosis

E) Elevated ANCA (anti-neutrophilic cytoplasmic antibodies) level.

9 Responses

  1. eeeeeeeeeee

  2. what is the correct answer? is it E ??

    • Erythema nodosum and Pyoderma Gangrenosum indicate poor prognosis in ulcerative colitis. Other poor prognostic features in UC are lymphopenia, pancolitis and hypoalbuminemia.
      Proctitis indicate left sided involvement only , better than pancolitis. ANCA has no prognostic value

      • Dear usmlegalaxy can you please indicate which paper the evidence comes from? I checked major serch engines and surgery textbooks and did not find such evidence. Thanks.

      • Prognosis and prognostic factors in inflammatory bowel disease are Hypoalbuminemia, anemia and raised inflammatory markers are laboratory markers which suggest a worse prognosis in the short and possibly long-term.—http://www.ncbi.nlm.nih.gov/pubmed/19864844

  3. Its about the the markers so i will say ANCA LEVELS. i could be wrong but i alway go with symptoms when i judge severity of disease

  4. I have looked and read about erythema nod and US and it just says you may see it but there is No indication of poor prognosis

  5. Poor in UC, Good in Sarcoidosis

  6. bbb

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