PMC6267462_01
(A) Skin biopsy with diffuse dense neutrophil infiltration confirming diagnosis of pyoderma gangrenosum, H&E stain at x20 magnification. (B) Liver biopsy demonstrating onion skin appearance of periductal fibrosis highly suggestive for primary sclerosing cholangitis, Masson stain at x20 magnification.
bmjgast-2018-000239f01.jpg
PMC6267462_01_bmjgast-2018-000239f01.jpg
F1
A punch biopsy was performed on the lesion on her lower limb, and the features of pyoderma gangrenosum were observed, see figure 1 (panel A). The liver biopsy was performed uneventfully, and features of PSC were noted, see figure 1 (panel B).
The effect of proctocolectomy on liver function tests in primary sclerosing cholangitis. bilirubin is not displayed because the patient never had an abnormal result. UC, ulcerative colitis.
bmjgast-2018-000239f02.jpg
PMC6267462_01_bmjgast-2018-000239f02.jpg
F2
Interestingly, by this point, it was noted that the patient's liver function tests had improved significantly (figure 2).