SHM Converge Scientific Abstract ePoster Gallery-Beyond Infection: Recognizing Aseptic Abscess Syndrome in Ulcerative Colitis

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This case highlights aseptic abscess syndrome (AAS), a rare extraintestinal complication of ulcerative colitis that can mimic infection. A 48-year-old woman with active ulcerative colitis developed 2 weeks of progressive right forearm pain, hematochezia, and right-sided abdominal pain. She was afebrile but tachycardic, with elevated inflammatory markers (CRP 178 mg/L) and markedly elevated fecal calprotectin. MRI showed a 2.6 × 5.6 cm intramuscular rim-enhancing collection with surrounding myositis, while CT abdomen/pelvis showed long-segment active colitis.<br /><br />Despite incision and drainage, broad-spectrum antibiotics, and repeated cultures, no organism was identified and the forearm collection recurred. Pathology showed fibrinopurulent debris without granulomas. Because of persistent symptoms, negative cultures, lack of antibiotic response, and active inflammatory bowel disease, AAS was suspected. IV methylprednisolone 60 mg daily led to rapid clinical improvement and falling inflammatory markers, supporting the diagnosis. She was discharged on a prednisone taper, though recurrence occurred near the end of the taper, illustrating the relapse risk.<br /><br />Key teaching points are that AAS can present as deep sterile abscess-like lesions, including intramuscular disease, and is often indistinguishable from an infectious abscess at first presentation. Clinical clues include recurrent abscesses, sterile cultures, failure of antibiotics, and concurrent inflammatory bowel disease. Corticosteroids are the cornerstone of treatment and usually produce prompt improvement. However, relapse is common, occurring in about 40–60% of patients, so longer-term management may require biologic therapy or colchicine.<br /><br />Early recognition of AAS can prevent unnecessary surgery, prolonged antibiotic exposure, and delayed effective immunosuppressive treatment.

Asset Subtitle

George A. Butros

Meta Tag

Author List George A. Butros, Hirotaka Kato, Yugant Patel

Category Clinical Vignettes

Concept Aseptic Abscess Syndrome

Concept Ulcerative Colitis

Concept Infectious Abscess

Concept Extra-pancreatic manifestation

Concept Corticosteroid

Distinguished Non-Finalist

Presenter Organization University of Kentucky College of Medicine

Presenting Author George A. Butros

Track Adult

Keywords

aseptic abscess syndrome

ulcerative colitis

sterile abscess

intramuscular collection

myositis

negative cultures

corticosteroid therapy

inflammatory bowel disease

relapse risk

biologic therapy

Aseptic Abscess Syndrome

Ulcerative Colitis

Infectious Abscess

Extra-pancreatic manifestation

Corticosteroid