Skin lesions and chest pain in a patient with Crohn’s disease

Abstract

A male patient aged 28 years with an 8-year history of ileal Crohn’s disease was started on combination therapy with infliximab and azathioprine 12 months ago. He was maintained on infliximab at a dose of 5 mg/kg administered every 8 weeks, and achieved sustained clinical remission. After receiving his sixth dose of infliximab, the patient developed intensely pruritic, erythematous papules and pustules on the palms and soles, associated with desquamation (figure 1A,B). This was followed by acneiform eruptions on the back (figure 1C), and subsequently, similar lesions appeared on the face, scalp and postauricular areas. Concurrently, he reported acute-onset, rapidly progressing chest pain predominantly localised to the sternoclavicular and sternocostal joints. Physical examination revealed marked tenderness over the costochondral joints. A comprehensive cardiac workup—including ECG, serum troponin levels and stress echocardiography—was unremarkable. However, chest MRI demonstrated bone marrow oedema at …