Crohn's disease, relapsing polychondritis and epidermolysis bullosa acquisita: an immune-mediated inflammatory syndrome

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Abstract
Sir, We report the case of a 22-yr-old Caucasian woman admitted to hospital due to frank haemoptysis associated with cutaneous lesions in hands and feet, congestion of the upper airway tract, episcleritis and impaired phonation. She had a 2-yr history of Crohn's disease (CD), diagnosed by colonoscopy and intestinal biopsy, in remission under methotrexate treatment (12.5 mg/week). She referred progressive association of bilateral eyelid retraction with epifora, nasal congestion with saddle nose deformity and recurrent episodes of skin eruption associated with trauma over the knuckles, elbows and extensor surfaces of the arms, unresponsive to therapy and characterized by areas of well-demarcated erythema that evolved to bullae over a few days and healed with scarring and milia.

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