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Internal Medicine
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Internal Medicine
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Internal Medicine
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Internal Medicine
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Clinical Science
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Case Report
Abstract
Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease often complicated by extraintestinal manifestations, with skin involvement seen in up to 15% of patients. Typical lesions include erythema nodosum and pyoderma gangrenosum, but abscess-like cutaneous lesions are almost always assumed to be infectious. Rare case reports describe sterile, culture-negative abscesses arising during UC flares, yet their true prevalence is unknown. We present the case of a young man with UC who developed multiple aseptic skin abscesses in parallel with active proctitis.
Case Presentation: A 19-year-old man with prior Clostridioides difficile infection and subtotal colectomy (rectal preservation) presented with malaise, painful skin lesions, and bloody diarrhea. He had never been formally diagnosed with ulcerative colitis and was not on maintenance therapy. Examination revealed a 5 × 5 cm cheek abscess with serosanguineous drainage, smaller abscesses on the thigh and back, and oral ulcers. During admission, new abscesses appeared on the neck, abdomen, and groin. Labs showed leukocytosis, anemia, and elevated inflammatory markers; stool and blood cultures were negative, as were HIV testing and wound cultures. Colonoscopy revealed severe rectal proctitis. Despite broad-spectrum antibiotics, clinical improvement occurred only after initiation of high-dose corticosteroids and mesalamine enemas. He was discharged on a steroid taper and oral antibiotics, and at follow-up his symptoms and skin lesions had fully resolved.
Conclusions: Cutaneous manifestations of ulcerative colitis (UC) are well described, most often as erythema nodosum or pyoderma gangrenosum. In contrast, sterile abscess-like lesions are not considered part of the typical UC spectrum and are reported mainly as isolated case reports. In our patient, multiple abscesses appeared during an intestinal flare, cultures remained repeatedly negative, there was little response to antibiotics, and both gastrointestinal and skin findings improved only after corticosteroid therapy. Unlike most published UC-related aseptic abscess presentations—which frequently involve visceral sites such as the spleen or lymph nodes—this episode was predominantly cutaneous and coincided with severe endoscopic proctitis. Key mimics, including bacterial abscesses, early pyoderma gangrenosum, and hidradenitis suppurativa, were less likely given sterile microbiology, absence of ulcerative evolution or chronic apocrine distribution features, and rapid steroid responsiveness. Although UC patients are at increased risk for true skin and soft-tissue infections, this case highlights a diagnostic blind spot: abscess-like lesions may occasionally reflect inflammatory activity rather than infection. Recognizing this pattern during flares can reduce unnecessary antimicrobial exposure and support timely initiation of appropriate immunosuppression.
Recommended Citation
Loayza Pintado, Jose J.; Aqeel, Mohammad; Aboytes Trevino, Jorge; Ajani, Taiwo; and Suarez, Andres, "A Flare Beyond the Gut: Culture-Negative Skin Abscesses in Ulcerative Colitis" (2026). Research Symposium. 10.
https://scholarworks.utrgv.edu/somrs/2026/talks/10
Included in
A Flare Beyond the Gut: Culture-Negative Skin Abscesses in Ulcerative Colitis
Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease often complicated by extraintestinal manifestations, with skin involvement seen in up to 15% of patients. Typical lesions include erythema nodosum and pyoderma gangrenosum, but abscess-like cutaneous lesions are almost always assumed to be infectious. Rare case reports describe sterile, culture-negative abscesses arising during UC flares, yet their true prevalence is unknown. We present the case of a young man with UC who developed multiple aseptic skin abscesses in parallel with active proctitis.
Case Presentation: A 19-year-old man with prior Clostridioides difficile infection and subtotal colectomy (rectal preservation) presented with malaise, painful skin lesions, and bloody diarrhea. He had never been formally diagnosed with ulcerative colitis and was not on maintenance therapy. Examination revealed a 5 × 5 cm cheek abscess with serosanguineous drainage, smaller abscesses on the thigh and back, and oral ulcers. During admission, new abscesses appeared on the neck, abdomen, and groin. Labs showed leukocytosis, anemia, and elevated inflammatory markers; stool and blood cultures were negative, as were HIV testing and wound cultures. Colonoscopy revealed severe rectal proctitis. Despite broad-spectrum antibiotics, clinical improvement occurred only after initiation of high-dose corticosteroids and mesalamine enemas. He was discharged on a steroid taper and oral antibiotics, and at follow-up his symptoms and skin lesions had fully resolved.
Conclusions: Cutaneous manifestations of ulcerative colitis (UC) are well described, most often as erythema nodosum or pyoderma gangrenosum. In contrast, sterile abscess-like lesions are not considered part of the typical UC spectrum and are reported mainly as isolated case reports. In our patient, multiple abscesses appeared during an intestinal flare, cultures remained repeatedly negative, there was little response to antibiotics, and both gastrointestinal and skin findings improved only after corticosteroid therapy. Unlike most published UC-related aseptic abscess presentations—which frequently involve visceral sites such as the spleen or lymph nodes—this episode was predominantly cutaneous and coincided with severe endoscopic proctitis. Key mimics, including bacterial abscesses, early pyoderma gangrenosum, and hidradenitis suppurativa, were less likely given sterile microbiology, absence of ulcerative evolution or chronic apocrine distribution features, and rapid steroid responsiveness. Although UC patients are at increased risk for true skin and soft-tissue infections, this case highlights a diagnostic blind spot: abscess-like lesions may occasionally reflect inflammatory activity rather than infection. Recognizing this pattern during flares can reduce unnecessary antimicrobial exposure and support timely initiation of appropriate immunosuppression.
