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A 43-year-old woman was admitted due to tenesmus and perianal pain caused by a severe perianal skin ulcer (figure 1A). Fifteen years previously, she underwent a total proctocolectomy with ileal pouch–anal anastomosis due to pancolitis-type UC. Three years prior, she had two episodes of pouchitis responding to antibiotic therapy. Her laboratory tests revealed anaemia (haemoglobin level, 96 g/L), elevated C reactive protein level (11.9 mg/dL) and decreased serum albumin level (25 g/L).
Contributors JY and ST planned the study. KT and AT conducted a survey. AT submitted the study.
Disclaimer The authors declare that they have no current financial arrangement or affiliation with any organisation that may have a direct influence on their work. This statement confirms that informed consent was obtained from the patients for the publication of their information and images.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Niigata University.
Provenance and peer review Not commissioned; externally peer reviewed.