Sweet syndrome and erythema nodosum in steroid-refractory ulcerative colitis: Successful treatment with tacrolimus

Background: Inflammatory bowel disease is accompanied by cutaneous manifest ations in about 10%, of cases. Erythema nodosum and pyoderma gangraenosum a re most frequently observed, which often subside on treatment of the underl ying disease. Case Report: A 30-year-old male with a history of long-standing ulcerative colitis experienced an acute attack despite treatment with azathioprine. Fu rther he noticed dull red, elevated and tender maculae on the forelegs. A d isseminated and papulosquamous exanthema arose on the back of the trunk and the upper extremities without pruritus. Well-being was compromised and blo od sampling revealed an inflammatory response. High-dose steroids with anti biotics were without benefit until they were combined with tacrolimus, an i mmunosuppressive agent acting similar to ciclosporin. Remission occurred ra pidly and the skin lesions resolved. Six months later the patient is curren tly still in remission and developed no signs of recurrent exanthema.