Challenging case of ischemic colitis, necrotic cutaneous vasculitis and thromboembolic disease in an elderly patient with Sjogren’s syndrome

Sjogren’s syndrome is a chronic autoimmune condition characterized by reduced lacrimal and salivary gland secretions. In a minority of the cases, patients can develop rarer complications, such as vasculitis and, even less commonly, ischemic colitis. Herein, we present a challenging case of a 73-year-old woman with a background of Sjogren’s syndrome (SS) who initially presented with a purpuric rash on the right leg. She was initially managed with antibiotics and referred for an outpatient rheumatology review. A few days later, she was readmitted to the hospital generally unwell with a widespread rash. She developed deep vein thrombosis and per rectal bleeding secondary to ischemic colitis. She had excellent response to medical management including steroid therapy and azathioprine. This case highlights the very rare complications of SS. Whilecutaneous vasculitis is not uncommon in primary Sjogren’s, ischemic colitis is very rare and is a potentially serious complication, which requires prompt diagnosis and management.