Discussion
In this case report, we highlight and present a unique and uncommon
clinical scenario involving 75-year-old patient with a history of
ulcerative colitis. To the best of our knowledge this is the first case
of ulcerative colitis associated mononeuritis multiplex. The exact
etiology and cause of ulcerative colitis remain incompletely understood,
and it is believed to be a complex interplay of genetic, environmental,
immunological, and microbial factors(5). Mononeuritis multiplex is a
rare neurological disorder characterized by multifocal nerve damage(6).
These two distinct diseases may have some connections in the context of
extraintestinal manifestations of UC and autoimmune processes.
Ulcerative colitis (UC) and mononeuritis multiplex appear to stem from
similar underlying processes - an aberrant immune reaction. The
inflammatory bowel disease known as UC arises when the immune system
overreacts within the gastrointestinal tract, provoking inflammation and
sores in the colon. Mononeuritis multiplex occurs due to the immune
system assaulting peripheral nerves, impairing neurological function.
Although UC centers around the digestive system while mononeuritis
multiplex involves nerve damage, the common autoimmune component points
to a plausible association between these two conditions. Uncovering the
precise immune pathways responsible could clarify how an overactive
immune system in UC may occasionally give rise to nerve inflammation and
injury remotely, manifesting as mononeuritis multiplex. Elucidating the
mechanisms linking intestinal autoimmunity with neuronal autoimmunity
will enable better understanding of the scope of extraintestinal
manifestations in inflammatory bowel disease.
The precise etiology and pathophysiology underlying both ulcerative
colitis (UC) and mononeuritis multiplex remain incompletely elucidated,
likely involving a constellation of factors(7). Given the intricate
nature of autoimmune diseases and their potential for systemic effects,
overlapping mechanisms could potentially contribute to the pathogenesis
of both conditions. However, direct causal links between UC and
mononeuritis multiplex are yet to be established, and they constitute
distinct clinical entities. Nevertheless, indirect associations such as
autoimmune processes and shared immune system involvement imply that
individuals with UC may be at heightened risk for developing other
autoimmune diseases, including mononeuritis multiplex. Therefore, UC
patients presenting with unexplained neurological signs and symptoms
warrant comprehensive diagnostic workup to exclude neurological
complications like mononeuritis multiplex, followed by prompt initiation
of appropriate therapy. Further research into the complex immunological
interactions in UC and the mechanisms underlying secondary systemic
manifestations like mononeuritis multiplex will provide greater insight
into the spectrum of extraintestinal disease in patients with
inflammatory bowel disease.
R. Okiyama et.al presented a case of a 40-year-old woman experienced
rectal bleeding, diarrhea, weight loss, and tenesmus, leading to a
diagnosis of ulcerative colitis affecting the ascending colon to the
rectum. Initial treatment with oral salazosulfapyridine (SASP) was
effective, resulting in a remission lasting 7 years. UC exacerbation
occurred, prompting treatment with higher SASP and prednisolone. SASP
was stopped due to suspected side effects, after which the patient
experienced a severe UC relapse, accompanied by paresthesia and weakness
in the lower extremities and right hand. This patient presented with
acute mononeuritis multiplex characterized by distinct right-sided
predominance. Nerve conduction studies and biopsy supported axonal
degeneration as the primary neuropathological process. Notably, the
neuropathy’s development and course closely paralleled UC activity,
suggesting a strong correlation. This case represents a unique
manifestation of neuropathy associated with UC(8).
F. Tripodi Cutrì et.al reported ulcerative colitis associated with
leukocytoclastic vasculitis of the skin. Ulcerative colitis may be
associated with a number of skin lesions such as erythema nodosum and
pyoderma gangrenosum. They describe an unusual case of a
33-year-old-caucasian male with ulcerative colitis and skin lesions
diagnosed as leukocytoclastic vasculitis. An initial treatment with oral
deflazacort led to little benefit, while treatment with oral Mesalasine
caused remission of the skin and intestinal manifestations in 2
weeks(9).
Scott R Levin et.al presented a prime example of the diverse
extraintestinal manifestations that can accompany inflammatory bowel
disease. As illustrated by the 58-year-old female described, ulcerative
colitis may present atypically with a constellation of cutaneous,
ocular, arthritic and hematologic abnormalities prior to the onset of
gastrointestinal symptoms. The tender skin lesions with characteristic
palmoplantar distribution, biopsy findings showing neutrophilic
infiltration, and resolution with ulcerative colitis treatment
collectively confirm the diagnosis of neutrophilic dermatosis(10). This
rare dermatosis highlights the neutrophil-mediated inflammation that
likely underpins many extra-intestinal manifestations of IBD. The
episodic course and response to systemic steroids aligns with previous
reports of neutrophilic dermatoses in IBD.