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.