Relapsing polychondritis and ulcerative colitis

Sir, A 53-year-old Caucasian woman was admitted with 2 weeks of intensifying diffuse neck pain and a 40°C fever despite the use of NSAIDs and antibiotics. Medical history included episodes of costochondritis, recurrent migraines and, for 20 years, ulcerative colitis (UC) that is now in remission. A complete blood count showed a hemoglobin of 116 g/L, 18,000 white blood cells/mm3and 816,000 platelets/mm3. She had elevated liver enzymes: Gamma glutamyl transpeptidase 116 U/L, alkaline phosphatase 212 U/L and alanine aminotransferase 178 U/L. The results of blood cultures, urinary sediment, kidney function, chest X-ray, C3, C4, rheumatoid factor, cryoglobulins, antineutrophil antibodies (ANA) and antinuclear cytoplasmic antibody (ANCA) were all normal or negative. Head and neck CT and MRI showed one questionably abnormal looking disk. Anticollagen antibodies were not examined. After a week of her hospital stay, the neck pain of the patient had resolved, but she had developed painful erythematous swelling of the eyelids [Figure 1] and nose [Figure 2]. She admitted to a few similar but milder previous episodes that had spontaneously resolved. Gallium scan confirmed an active inflammatory process in those structures [Figure 3]. She declined colonoscopy. Relapsing polychondritis (RPC) was diagnosed and 30 mg of prednisone administered QD. She responded very well clinically, as CRP decreased from 160 to 3.7 mg/dl in the following week. After 18 months, our patient is without recurrence of RPC or UC without administration of steroids. RPC is a rare, debilitating autoimmune disease of cartilages. Its diagnosis is clinical[1]; no specific test is available, its actiology is unknown[2] and it can be associated with systemic non-organ-specific connective tissue diseases, most often a vasculitis and, with organ-specific autoimmune diseases such as thyroid or inflammatory bowel diseases. The patient in our study is a rare example of the association of UC with RPC. Her RPC symptoms were atypical and mild, while her UC was judged to be clinically inactive. Nuclear medicine imaging provided a minimally invasive clue to correct diagnosis.Figure 1: Swelling of the eyelidsFigure 2: Chondritis of the noseFigure 3: Gallium scan showing increased uptake in the area of the eyes and nose

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