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RELAPSING POLYCHONDRITIS IN A PATIENT WITH ULCERATIVE COLITIS: A CASE REPORT
M Almadi, Y Tahiri, E Mac Namara
Department of Gastroenterology, Royal Victoria Hospital, McGill University, Montreal, Quebec
BACKGROUND: Relapsing polychondritis (RPC) is a unique, rare autoimmune disorder in which cartilage and its related connective tissue structures throughout the body are structurally affected, although its aetiology is unknown there has been a linked to HLA-DR4 and other autoimmune diseases.
Case: A 53 year-old Caucasian woman known to have ulcerative colitis developed diffuse neck pain and fever over the course of two weeks prior to her presentation. Her examination was normal apart from a fever of 40 degrees Celsius and diffuse neck tenderness. The only abnormal laboratory investigation she had was a white blood cell count of 18.1 and mildly elevated liver enzymes. .An MRI of the neck showed increased uptake in one of the cervical intervertebral disks. Blood cultures were negative. Her Anti-Nuclear Antibodies and Anti-Neutrophilic Cytoplasmic Antibodies were also negative. A week through her admission, the patient’s neck pain resolved, but she developed swelling of her nose associated with pain and erythema. Concomitantly, she developed scleritis. On further questioning, she admitted to previous episodes of similar symptoms and a past history of costochondritis. A gallium scan confirmed an active inflammatory process at the level of her nose and diagnosis of RPC was made. The patient was started on prednisone 30 mg per day, and her response was dramatic. Within three days, she was discharged home. Her C-reactive protein and erythrocyte sedimentation rate decreased from 150 to 3.7 mg/dL and from 70 to 23 mm/h respectively.
CONCLUSION: This is the fourth report, to our knowledge, of the association of UC with RPC in the English literature. This condition has significant morbidity and may be unrecognized unless gastroenterologists maintain a high index of suspicion. This case report highlights the clinical entity and discusses other options for its management, including potential use of infliximab.