| Sumario: | Introduction: Paediatric Inflammatory Bowel Disease (PIBD) represents a major psychosocial issue, given its detrimental effects on patients' quality of life, growth and puberty, nutritional and bone status, as well as increased healthcare costs. Case Report: A 15-year-old female was admitted to our clinic in June 2023, presenting 10-15 bloody watery stools/day, postprandial vomiting, involuntary weight loss (8 kg.), altered general condition, episcleritis, and multiple vesicular lesions resembling a herpetic infection. First symptoms were noted in January 2023, 1-2 semi-solid stools/day, intermittently bloody. The paediatrician recommended treatment with oral Sulfasalazine for one month, without any endoscopic/imaging investigation. In our clinic, colonoscopy revealed a "cobblestone appearance" of the transverse colon and continuous inflammatory changes distally; upper endoscopy was normal. The case was initially interpreted as severe Crohn's disease (CD), prompting initiation of Methylprednisolone therapy and exclusive enteral nutrition. Histological examination revealed active severe Ulcerative Colitis (ASUC). The disease course was unfavourable under the above-mentioned therapy, with persistent bloody stools, requiring blood transfusions and albumin administrations, severe activity, and development of multilocular pyoderma gangrenosum. Consequently, Infliximab was initiated as rescue therapy (recommended in both PIBD types) with prompt excellent response, both intestinal and extraintestinal. The patient was discharged with a PUCAI score of 5. Eight months later, our patient maintains a complete clinical, endoscopic, and histologic remission. Discussions : We presented a case of ASUC associated with rare complications, multilocular pyoderma gangrenosum and episcleritis, with a remarkable improvement shortly after Infliximab therapy. Notable is the initial appearance of pyoderma gangrenosum resembling a herpetic infection. The severe endoscopic aspect in the transverse colon with transmural inflammation associated with milder mucosal oedema distally is also worth mentioning. Conclusions: Patients presenting with bloody diarrhea should have accurate testing, recommended by current guidelines, before administration of any therapy. The 5-months delay in diagnosis caused an extremely stressful period for our patient, resulting in a moderate depressive episode, exacerbation of the digestive symptoms, weight loss of 8 kg., requiring albumin and blood transfusions, a prolonged corticosteroid treatment and the need of biological therapy to induce remission. Thus, we want to emphasize the importance of a comprehensive diagnosis work-up in PIBD, established through clinical, biological, coprological, imaging, endoscopic, and histological evidence, as well as the need for prompt treatment; otherwise, invalidating complications may occur.
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