A 30-year-old man presents with 4 months of bloody diarrhea, fecal urgency, and intermittent lower abdominal cramping. He has no significant past medical history and takes no medications. Temperature is 37.3°C (99.1°F), blood pressure is 122/78 mm Hg, pulse is 88/min, and respiratory rate is 14/min. Physical examination reveals mild diffuse lower abdominal tenderness. Laboratory studies show a hemoglobin level of 11.5 g/dL and an elevated erythrocyte sedimentation rate. Colonoscopy reveals continuous inflammation extending proximally from the rectum.
Which of the following extraintestinal manifestations is most strongly associated with this disease?
The correct answer is:
A: Erythema nodosum.
This patient has ulcerative colitis, which is characterized by continuous mucosal inflammation beginning in the rectum. Ulcerative colitis is associated with several extraintestinal manifestations, including erythema nodosum, peripheral arthritis, uveitis, and primary sclerosing cholangitis. Recognition of these findings is important because they may precede or accompany gastrointestinal symptoms.
Answer choice B: Nephrolithiasis, is incorrect.
Kidney stones are more commonly associated with Crohn disease, particularly when the terminal ileum is involved. Fat malabsorption increases oxalate absorption and stone formation.
Answer choice C: Pancreatic pseudocyst, is incorrect.
Pancreatic pseudocysts are complications of acute pancreatitis rather than inflammatory bowel disease.
Answer choice D: Perianal fistula, is incorrect.
Perianal fistulas are strongly associated with Crohn disease because of transmural inflammation. Ulcerative colitis typically involves only the mucosa and submucosa.
Answer choice E: Vitamin B12 deficiency, is incorrect.
Vitamin B12 deficiency usually results from terminal ileal disease or resection and is therefore more characteristic of Crohn disease.
Key Learning Point
Ulcerative colitis causes continuous colonic inflammation beginning in the rectum and is associated with extraintestinal manifestations such as erythema nodosum and primary sclerosing cholangitis.
