Association of Butterfly Rash and Antinuclear Antibody Positivity with Inflammatory Bowel Disease

A 30 year old female presented with diarrhoea and gastrointestinal bleeding, along with photosensitive rash over malar region of face. Clinically she had features of essential nutrients deficiency, extra intestinal manifestations of inflammatory bowel disease and malar rash typical of systemic lupus erythematosus (SLE). On evaluation she found to have hypothyroidism and features consistent with inflammatory bowel disease, with significantly high titres of antinuclear antibody (++++). According to 2012 SLICC SLE criteria she did not have any other features consistent with SLE. Inflammatory bowel disease was confirmed by histopathological examination showing non-caseating granuloma with no evidence of vasculitis. Patient was started on treatment with systemic corticosteroids and thyroxine supplementation. Patient responded well. No flare up of symptoms or appearance of any new symptoms during her regular follow up.

Conclusion: We conclude that, clinical and laboratory features mimicking SLE like butterfly rash, positive antinuclear antibody can occur in inflammatory bowel disease even in absence of SLE making them difficult to diagnose. But either of the patients should be regularly followed up to look for the development of the other disease. Not only graves, association of hypothyroidism following hashimotos thyroiditis is also seen with inflammatory bowel disease.