Unusual cause of bloody stool with earache and saddle-nose deformity

A 41-year-old female patient was admitted to hospital with bloody stool and diarrhoea for 2 months, accompanied with fever, left earache, obvious saddle-nose deformity and red eyes for 2 weeks. She had history of repeated multiple sore joints for 6 months and hearing impairment in the left ear for 4 months. Laboratory tests showed elevated white cell count (WBC) of 15.57×10ˆ9/L, neutrophil of 76.8% and C reactive protein (CRP) of 95.4 mg/L. Haemoglobin was decreased at 94 g/L. Antineutrophil cytoplasmic antibody was negative. Colonoscopy showed diffuse inflammation and ulcers in the left-sided colon (figure 1). Histological findings from sigmoid colon showed chronic inflammation without vasculitis appearance. CT enterography revealed left-sided colon inflammation (figure 2). MRI of …