STICKY NEUTROPHILS, PATHERGIC ARTHRITIS, AND RESPONSE TO HEPARIN IN PYODERMA-GANGRENOSUM COMPLICATING ULCERATIVE-COLITIS

Pyoderma gangrenosum is strongly associated with inflammatory bowel di sease and exhibits pathergy, occurring at sites of previous minor trau ma. A patient is presented with a 21 year history of extensive ulcerat ive colitis, who developed pyoderma gangrenosum and arthralgia while r eceiving high dose corticosteroids for active ulcerative colitis. The arthralgia exhibited pathergy affecting particularly the left temporom andibular joint, which was stressed by an asymmetric bite, and the lef t elbow, which had been fractured many years previously. This prompted the hypothesis that neutrophils in this condition may be marginated, as a result of increased stickiness of either the neutrophil or the va scular endothelium. The introduction of heparin therapy was associated with rapid resolution of the arthralgia, pyoderma gangrenosum, and ul cerative colitis.