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A Crohn’s disease patient with pustules and fever
  1. G Bouma1,
  2. S Neve2,
  3. N C T van Grieken3,
  4. C J Mulder1,
  5. T J Stoof2
  1. 1
    Department of Gastroenterology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
  2. 2
    Department of Dermatology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
  3. 3
    Department of Pathology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr G Bouma, Department of Gastroenterology, Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; g.bouma{at}vumc.nl

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Clinical presentation

A woman in her thirties was recently diagnosed with Crohn’s disease involving the oesophagus and colon. In addition, she had aphtous mouth ulcers and peri-anal fistulas. She was successfully treated with steroids, 6-mercaptopurine (6-MP) and infliximab. Two months later she presented with a flare-up of disease and recurrence of the mouth ulcers. In addition, she had fever up to 39°C, arthralgias and pustules on her back and buttocks (fig 1). Blood tests revealed an erythrocyte sedimentation rate (ESR) of 44 mm/h, C-reactive protein (CRP) of 65 mg/l and leucocytes of 13×109/litre. Blood, urinary and stool cultures as well as chest x ray did not reveal an infectious cause of …

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