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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).
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