SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2023 | VOLUME 21 | ISSUE 1 | 22 CASE REPORT We report a 42-year-old woman from the West Coast of South Africa, known with oculocutaneous albinism diagnosed in childhood and penetrating colonic Cronh’s Disease (CD), on azathioprine for 3 years who subsequently developed both cutaneous squamous cell (SCC) and basal cell carcinoma (BCC). She reported no family history of malignancy or inflammatory bowel disease (IBD). She was a previous smoker (10 pack years), moderate social alcohol use (8 units per week) and spent time outdoors walking along the beach. In 2016, at age 36 she initially presented to a peripheral hospital with a longstanding history of loose stools and intermittent abdominal pain prompting colonoscopy. CD’s disease was diagnosed with isolated penetrating colon involvement categorized as A2L2B3 according to the Montreal classification. Her initial treatment comprised of dual 5-aminosalicyclic acid (5-ASA) therapy which included oral sulphasalazine (1.5g three times daily) and rectal mesalamine (1g daily) for two years with intermittent courses of oral prednisone. Whilst on dual 5-ASA therapy, she remained symptomatic with lifestyle limiting abdominal pain and increased stool frequency. We were consulted for further management and repeat colonoscopy revealed multiple large pseudo-polyps and inflammatory changes in keeping with moderate to severely active colonic CD’s disease. Dual 5-ASA therapy was discontinued, and azathioprine (2.5mg/ kg) was initiated. She had a favourable response and maintained a clinical remission with a Crohn’s Disease Activity Index of <150 during her subsequent follow up visits. Three years after initiating azathioprine and during a routine clinical follow-up visit, she complained of multiple pruritic lesions involving her face, neck, and upper chest (Figure 1). She had first noticed these lesions developing in the preceding three months and had been self-medicating with topical emollients with no benefit. Figure 1. Hypertrophic and ulcerated skin lesions involving sun exposed areas namely the (a) left cheek (b) left side of the neck (c) and anterior aspect of the chest. Non-Melanoma skin cancer risk associated with Thiopurine use in Inflammatory Bowel Disease DC Peterson 1 AC van Wyk 2 , MS Gabriel 1 , O Etwati 1 1 Department of Gastroenterology and Hepatology, Tygerberg Academic Hospital, Francie Van Zyl, Tygerberg Hospital, Cape Town, South Africa 2 Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa Correspondence Dale Christopher Peterson email: dalepeterson2@hotmail.com