51
|
Olpin JD, Sjoberg BP, Stilwill SE, Jensen LE, Rezvani M, Shaaban AM. Beyond the Bowel: Extraintestinal Manifestations of Inflammatory Bowel Disease. Radiographics 2017; 37:1135-1160. [PMID: 28548906 DOI: 10.1148/rg.2017160121] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Inflammatory bowel disease (IBD) is a chronic, relapsing immune-mediated inflammation of the gastrointestinal tract. IBD includes two major disease entities: Crohn disease and ulcerative colitis. Imaging plays an important role in the diagnosis and surveillance of these complex disorders. Computed tomographic and magnetic resonance enterographic techniques have been refined in recent years to provide a superb means of evaluating the gastrointestinal tract for suspected IBD. Although the intestinal imaging manifestations of IBD have been extensively discussed in the radiology literature, extraintestinal imaging manifestations of IBD have received less attention. Multiple extraintestinal manifestations may be seen in IBD, including those of gastrointestinal (hepatobiliary and pancreatic), genitourinary, musculoskeletal, pulmonary, cardiac, ocular, and dermatologic disorders. Although many associations between IBD and extraintestinal organ systems have been well established, other associations have not been fully elucidated. Some extraintestinal disorders may share a common pathogenesis with IBD. Other extraintestinal disorders may occur as a result of unintended treatment-related complications of IBD. Although extraintestinal disorders within the abdomen and pelvis may be well depicted with cross-sectional enterography, other musculoskeletal and thoracic disorders may be less evident with such examinations and may warrant further investigation with additional imaging examinations or may be readily apparent from the findings at physical examination. Radiologists involved in the interpretation of IBD imaging examinations must be aware of potential extraintestinal manifestations, to provide referring clinicians with an accurate and comprehensive profile of patients with these complex disorders. © RSNA, 2017.
Collapse
Affiliation(s)
- Jeffrey D Olpin
- From the Department of Diagnostic Radiology (J.D.O., S.E.S., L.E.J., M.R., A.M.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; and the Department of Diagnostic Radiology, University of Wisconsin, Madison, Wis (B.P.S.)
| | - Brett P Sjoberg
- From the Department of Diagnostic Radiology (J.D.O., S.E.S., L.E.J., M.R., A.M.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; and the Department of Diagnostic Radiology, University of Wisconsin, Madison, Wis (B.P.S.)
| | - Sarah E Stilwill
- From the Department of Diagnostic Radiology (J.D.O., S.E.S., L.E.J., M.R., A.M.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; and the Department of Diagnostic Radiology, University of Wisconsin, Madison, Wis (B.P.S.)
| | - Leif E Jensen
- From the Department of Diagnostic Radiology (J.D.O., S.E.S., L.E.J., M.R., A.M.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; and the Department of Diagnostic Radiology, University of Wisconsin, Madison, Wis (B.P.S.)
| | - Maryam Rezvani
- From the Department of Diagnostic Radiology (J.D.O., S.E.S., L.E.J., M.R., A.M.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; and the Department of Diagnostic Radiology, University of Wisconsin, Madison, Wis (B.P.S.)
| | - Akram M Shaaban
- From the Department of Diagnostic Radiology (J.D.O., S.E.S., L.E.J., M.R., A.M.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; and the Department of Diagnostic Radiology, University of Wisconsin, Madison, Wis (B.P.S.)
| |
Collapse
|
52
|
Miloslavsky EM, Stone JH, Moy AP. Case 14-2017 - A 20-Year-Old Man with Pain and Swelling of the Left Calf and a Purpuric Rash. N Engl J Med 2017; 376:1868-1877. [PMID: 28489991 DOI: 10.1056/nejmcpc1616397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Eli M Miloslavsky
- From the Departments of Medicine (E.M.M., J.H.S.) and Pathology (A.P.M.), Massachusetts General Hospital, and the Departments of Medicine (E.M.M., J.H.S.) and Pathology (A.P.M.), Harvard Medical School - both in Boston
| | - John H Stone
- From the Departments of Medicine (E.M.M., J.H.S.) and Pathology (A.P.M.), Massachusetts General Hospital, and the Departments of Medicine (E.M.M., J.H.S.) and Pathology (A.P.M.), Harvard Medical School - both in Boston
| | - Andrea P Moy
- From the Departments of Medicine (E.M.M., J.H.S.) and Pathology (A.P.M.), Massachusetts General Hospital, and the Departments of Medicine (E.M.M., J.H.S.) and Pathology (A.P.M.), Harvard Medical School - both in Boston
| |
Collapse
|
53
|
|
54
|
IL-36α expression is elevated in ulcerative colitis and promotes colonic inflammation. Mucosal Immunol 2016; 9:1193-204. [PMID: 26813344 DOI: 10.1038/mi.2015.134] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 11/15/2015] [Indexed: 02/04/2023]
Abstract
A role for the IL-36 family of cytokines has been identified in the pathogenesis of psoriasis. Although significant mechanistic overlap can exist between psoriasis and inflammatory bowel disease (IBD), to date there have been no reports investigating the IL-36 family in gastrointestinal inflammation. Here we demonstrate that expression levels of IL-36α are specifically elevated in the colonic mucosa of ulcerative colitis patients. This elevated expression is mirrored in the inflamed colonic mucosa of mice, wherein IL-36 receptor deficiency confirmed this pathway as a mediator of mucosal inflammation. Il36r-/- mice exhibited reduced disease severity in an acute DSS-induced model of colitis in association with decreased innate inflammatory cell infiltration to the colon lamina propria. Consistent with these data, infection with the enteropathogenic bacteria Citrobacter rodentium, resulted in reduced innate inflammatory cell recruitment and increased bacterial colonization in the colons of il36r-/- mice. Il36r-/- mice also exhibited altered T helper cell responses in this model, with enhanced Th17 and reduced Th1 responses, demonstrating that IL-36R signaling also regulates intestinal mucosal T-cell responses. These data identify a novel role for IL-36 signaling in colonic inflammation and indicate that the IL-36R pathway may represent a novel target for therapeutic intervention in IBD.
Collapse
|
55
|
Ko JS, Uberti G, Napekoski K, Patil DT, Billings SD. Cutaneous manifestations in inflammatory bowel disease: a single institutional study of non-neoplastic biopsies over 13 years. J Cutan Pathol 2016; 43:946-955. [DOI: 10.1111/cup.12777] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/30/2016] [Accepted: 07/22/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Jennifer S. Ko
- Department of Pathology; Cleveland Clinic Foundation; Cleveland OH USA
| | - Georgina Uberti
- Department of Pathology; Cleveland Clinic Foundation; Cleveland OH USA
| | - Karl Napekoski
- Department of Pathology; Edward Hospital; Naperville IL USA
| | - Deepa T. Patil
- Department of Pathology; Cleveland Clinic Foundation; Cleveland OH USA
| | | |
Collapse
|
56
|
Raymond SB, Gee MS, Anupindi SA, Shailam R, Kaplan JL, Nimkin K. CT and MRI of Rare Extraintestinal Manifestations of Inflammatory Bowel Disease in Children and Adolescents. J Pediatr Gastroenterol Nutr 2016; 63:e1-9. [PMID: 27050046 DOI: 10.1097/mpg.0000000000001225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Inflammatory bowel disease (IBD) is associated with a spectrum of extraintestinal manifestations (EIMs) affecting many organ systems. EIMs can occur in more than 40% of patients with IBD and are associated with significant morbidity. They occur at any time point in the course of disease, often during an active phase of bowel inflammation, but sometimes preceding bowel disease. Prompt recognition of EIMs enables timely and more effective therapy. Physicians who image patients with IBD should be aware of the myriad extraintestinal conditions that may be detected on imaging studies, both within and outside of the abdomen, as they may predate the diagnosis of IBD. Cross-sectional imaging of unusual conditions associated with IBD will be presented, including pathology in the hepatobiliary, pancreatic, genitourinary, musculoskeletal, mucocutaneous, vascular, neurologic, and pulmonary systems.
Collapse
Affiliation(s)
- Scott B Raymond
- *Department of Radiology†Department of Radiology, Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA‡Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA§Department of Pediatrics, Division of Pediatric Gastroenterology, MassGeneral Hospital for Children, Boston, MA
| | | | | | | | | | | |
Collapse
|
57
|
Rispo A, Musto D, Imperatore N, Testa A, Rea M, Castiglione F. Dramatic improvement of severe acne pustolosa after adalimumab in a patient with ulcerative colitis. Clin Case Rep 2016; 4:348-50. [PMID: 27099725 PMCID: PMC4831381 DOI: 10.1002/ccr3.520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/19/2016] [Accepted: 02/03/2016] [Indexed: 11/07/2022] Open
Abstract
A 22‐year‐old male with extensive steroid‐dependent/azathioprine‐refractory ulcerative colitis and preexistent severe refractory acne pustolosa (AP) was successfully treated with adalimumab for both conditions. Severe AP could be considered a further indication, instead of a relative restriction, to anti‐TNFα in steroid‐dependent IBD patients needing therapy with this class of drugs.
Collapse
Affiliation(s)
- Antonio Rispo
- Gastroenterology - Department of Clinical Medicine and Surgery - School of Medicine "Federico II" of Naples Via S. Pansini 5 Naples 80131 Italy
| | - Dario Musto
- Gastroenterology - Department of Clinical Medicine and Surgery - School of Medicine "Federico II" of Naples Via S. Pansini 5 Naples 80131 Italy
| | - Nicola Imperatore
- Gastroenterology - Department of Clinical Medicine and Surgery - School of Medicine "Federico II" of Naples Via S. Pansini 5 Naples 80131 Italy
| | - Anna Testa
- Gastroenterology - Department of Clinical Medicine and Surgery - School of Medicine "Federico II" of Naples Via S. Pansini 5 Naples 80131 Italy
| | - Matilde Rea
- Gastroenterology - Department of Clinical Medicine and Surgery - School of Medicine "Federico II" of Naples Via S. Pansini 5 Naples 80131 Italy
| | - Fabiana Castiglione
- Gastroenterology - Department of Clinical Medicine and Surgery - School of Medicine "Federico II" of Naples Via S. Pansini 5 Naples 80131 Italy
| |
Collapse
|
58
|
Abstract
Awareness of the extraintestinal manifestations of Crohn disease is increasing in dermatology and gastroenterology, with enhanced identification of entities that range from granulomatous diseases recapitulating the underlying inflammatory bowel disease to reactive conditions and associated dermatoses. In this review, the underlying etiopathology of Crohn disease is discussed, and how this mirrors certain skin manifestations that present in a subset of patients is explored. The array of extraintestinal manifestations that do not share a similar pathology, but which are often seen in association with inflammatory bowel disease, is also discussed. Treatment and pathogenetic mechanisms, where available, are discussed.
Collapse
Affiliation(s)
- Joshua W Hagen
- Department of Dermatology, University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 5th Floor, Pittsburgh, PA 15213, USA
| | - Jason M Swoger
- Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop street, C-Wing, Mezzanine, Pittsburgh, PA 15213, USA
| | - Lisa M Grandinetti
- Department of Dermatology, University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 5th Floor, Pittsburgh, PA 15213, USA.
| |
Collapse
|
59
|
Malaty HM, Sansgiry S, Artinyan A, Hou JK. Time Trends, Clinical Characteristics, and Risk Factors of Chronic Anal Fissure Among a National Cohort of Patients with Inflammatory Bowel Disease. Dig Dis Sci 2016; 61:861-4. [PMID: 26514675 DOI: 10.1007/s10620-015-3930-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 10/12/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Chronic anal fissure (CAF) is a common problem that causes significant morbidity. Little is known about the risk factors of CAF among patients with inflammatory bowel disease (IBD). AIM To study the clinical characteristics and prevalence of CAF among a cohort of IBD patients. METHODS We performed a population-based study on IBD patients from the National Veterans Affairs administrative datasets from 1998 to 2011. IBD and AF were identified by ICD-9 diagnosis codes. RESULTS We identified 60,376 patients with IBD between the ages of 18-90 years, 94% males, 59% diagnosed with ulcerative colitis (UC), and 88% were Caucasians. The overall prevalence of CAF was 4% for both males and females. African Americans (AA) were two times more likely to have CAF compared to Caucasians (8 vs. 4%; OR 2.0, 95% CI 1.6-20.2, p = 0.0001) or Hispanics (8 vs. 4.8%; OR 2.1, 95% CI 1.4-25.2, p = 0.0001). The prevalence of CAF significantly dropped with age from 7% at age group 20-50 to 1.5% at 60-90 (p = 0.0001). CD patients were two times more likely to have CAF than UC patients (6 vs. 3%; OR 1.9, 95% CI 1.5-18.2, p = 0.0001). The initial diagnosis of CAF occurred within 14 years after the initial diagnosis of IBD in 74.5% patients. CONCLUSIONS CAF is more prevalent among IBD than what is reported in the general population and diagnosed after the diagnosis of IBD. CAF is more prevalent among patients with CD, younger patients, and AA. The current results lay the groundwork for further outcome studies relate to anal fissure such as utilization, hospitalization, and cost.
Collapse
Affiliation(s)
- Hoda M Malaty
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Shubhada Sansgiry
- VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Avo Artinyan
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jason K Hou
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| |
Collapse
|
60
|
Uzunçakmak TK, Akdeniz N, Karadağ AS, Çobanoğlu B. Pyodermatitis vegetans after total colectomy. Indian Dermatol Online J 2016; 6:S9-S11. [PMID: 26904460 PMCID: PMC4738526 DOI: 10.4103/2229-5178.171052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pyostomatitis-pyodermatitis vegetans (PPV) is a rare dermatological manifestation of inflammatory bowel disease, characterized by erythematous, vesiculopustular, exudative, annular, and/or vegetating plaques over the intertriginous regions that may precede or appear at the same time as the mucosal lesions. Systemic corticosteroids, dapsone, sulfasalazine, azathioprine, cyclosporine, and subtotal/total colectomy are the most common treatment options. A 16-year-old male patient presented to our outpatient clinic with a four months history of thickly crusted erosions on his trunk, back, and lower extremity. He had ulcerative colitis for four years and total colectomy was done seven months ago. Clinical and histopathological examination of his lesions were consistent with pyostomatitis vegetans. Although subtotal/total colectomy has been reported as a treatment option for PPV, lesions reappeared three months after total colectomy in our patient.
Collapse
Affiliation(s)
- Tuğba Kevser Uzunçakmak
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Necmettin Akdeniz
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayşe Serap Karadağ
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Bengü Çobanoğlu
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| |
Collapse
|
61
|
Kamal N, Cohen BL, Buche S, Delaporte E, Colombel JF. Features of Patients With Crohn's Disease and Hidradenitis Suppurativa. Clin Gastroenterol Hepatol 2016; 14:71-9. [PMID: 25956836 DOI: 10.1016/j.cgh.2015.04.180] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/12/2015] [Accepted: 04/21/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS There have been reports of an association between Crohn's disease and hidradenitis suppurativa, a chronic, relapsing, inflammatory condition of the skin. We investigated features of hidradenitis suppurativa in patients with Crohn's disease by analyzing clinical data and performing a literature review. METHODS We performed a retrospective study by using information from the Mount Sinai Medical Center database from 2003 through 2013; International Classification of Diseases, 9th Revision codes were used to identify patients who had both Crohn's disease and hidradenitis suppurativa. We identified a total of 18 patients with inflammatory bowel disease (15 with Crohn's disease, 3 with ulcerative colitis) and hidradenitis suppurativa. We also performed a systematic search for publications listed in PubMed through December 2013. RESULTS We identified 15 patients with Crohn's disease and hidradenitis suppurativa who met the inclusion criteria (11 women, 4 men). Nine patients were black, 5 were white, and 1 was Asian. Regions most affected by hidradenitis suppurativa included the axilla (53%), inguinal region (47%), and perianal region (73%). Seven patients had colonic Crohn's disease, and 8 had ileocolonic Crohn's disease; 10 patients had perianal disease. Fourteen patients received medical treatment for hidradenitis suppurativa and for Crohn's disease. Twelve patients were treated with tumor necrosis factor inhibitors for Crohn's disease (11 received infliximab and 4 received adalimumab). Nine patients required dose escalation; 11 responded to tumor necrosis factor inhibitors, and 8 required surgery. Four patients were treated with tumor necrosis factor inhibitors for hidradenitis suppurativa (all with infliximab). Three required a dose escalation; 4 responded to tumor necrosis factor inhibitors, and 3 required surgery. CONCLUSIONS Crohn's disease and hidradenitis suppurativa are severe inflammatory conditions that can develop in the same patient. They frequently require increased medical and surgical therapy.
Collapse
Affiliation(s)
- Natasha Kamal
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin L Cohen
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sebastien Buche
- Department of Dermatology, Hopital Huriez, CHU Lille, Lille, France
| | | | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
| |
Collapse
|
62
|
Blasco Alonso J, Girón Fernández-Crehuet F, Lendínez Ramírez MA, Gallego Gutiérrez S, Luque Pérez S, Serrano Nieto J, Navas López VM, Sierra Salinas C. Metastatic Crohns disease in pediatrics. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 108:598-603. [DOI: 10.17235/reed.2016.3948/2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
63
|
Marzano AV, Tavecchio S, Berti E, Gelmetti C, Cugno M. Cytokine and Chemokine Profile in Amicrobial Pustulosis of the Folds: Evidence for Autoinflammation. Medicine (Baltimore) 2015; 94:e2301. [PMID: 26683967 PMCID: PMC5058939 DOI: 10.1097/md.0000000000002301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Autoinflammation has recently been suggested in the pathogenesis of neutrophilic dermatoses but systematic studies on their cytokine profile are lacking. Notably, amicrobial pustulosis of the folds (APF), classified among neutrophilic dermatoses, has been studied only in small case series. In our University Hospital, we conducted an observational study on 15 APF patients, analyzing their clinical and laboratory features with a follow-up of 9 months to 20 years. Skin cytokine pattern of 9 of them was compared to that of 6 normal controls. In all patients, primary lesions were pustules symmetrically involving the skin folds and anogenital region with a chronic-relapsing course and responding to corticosteroids. Dapsone, cyclosporine, and tumor necrosis factor blockers were effective in refractory cases. In skin samples, the expressions of interleukin (IL)-1β, pivotal cytokine in autoinflammation, and its receptors I and II were significantly higher in APF (P = 0.005, 0.018, and 0.034, respectively) than in controls. Chemokines responsible for neutrophil recruitment such as IL-8 (P = 0.003), CXCL 1/2/3 (C-X-C motif ligand 1/2/3) (P = 0.010), CXCL 16 (P = 0.045), and RANTES (regulated on activation, normal T cell expressed and secreted) (P = 0.034) were overexpressed. Molecules involved in tissue damage like matrix metalloproteinase-2 (MMP-2) (P = 0.010) and MMP-9 (P = 0.003) were increased. APF is a pustular neutrophilic dermatosis with a typical distribution in all patients. The disorder may coexist with an underlying autoimmune/dysimmune disease but is often associated only with a few autoantibodies without a clear autoimmunity. The overexpression of cytokines/chemokines and molecules amplifying the inflammatory network supports the view that APF has an important autoinflammatory component.
Collapse
Affiliation(s)
- Angelo V Marzano
- From the Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy (AVM, ST, EB, CG) and Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Medicina Interna, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy (MC)
| | | | | | | | | |
Collapse
|
64
|
Rheumatic manifestations in inflammatory bowel diseases: a link between GI and rheumatology. Clin Rheumatol 2015; 35:291-6. [DOI: 10.1007/s10067-015-3116-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 11/08/2015] [Indexed: 12/18/2022]
|
65
|
Pustular Skin Reaction to Tumor Necrosis Factor Alpha Antagonists in Patients with Inflammatory Bowel Diseases. Inflamm Bowel Dis 2015; 21:E26-7. [PMID: 26422518 DOI: 10.1097/mib.0000000000000600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
66
|
Marzano AV, Tavecchio S, Berti E, Gelmetti C, Cugno M. Paradoxical Autoinflammatory Skin Reaction to Tumor Necrosis Factor Alpha Blockers Manifesting as Amicrobial Pustulosis of the Folds in Patients With Inflammatory Bowel Diseases. Medicine (Baltimore) 2015; 94:e1818. [PMID: 26559252 PMCID: PMC4912246 DOI: 10.1097/md.0000000000001818] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The therapy of inflammatory bowel disease, particularly with tumor necrosis factor (TNF) blockers, may be associated with a number of cutaneous adverse effects, including psoriasis-like, eczema-like, and lichenoid eruptions. Other rare skin complications are neutrophilic dermatoses such as amicrobial pustulosis of the folds (APF), which is a chronic relapsing pustular disorder classified in this spectrum.The authors analyzed clinical, histopathologic, and cytokine expression profiles of 3 inflammatory bowel disease patients with APF triggered by adalimumab (patient 1) and infliximab (patients 2 and 3).All 3 patients presented with sterile pustules involving the cutaneous folds, genital regions, and scalp 6 months after starting adalimumab (patient 1) and 9 months after starting infliximab (patients 2 and 3). Histology was characterized by epidermal spongiform pustules with a dermal neutrophilic and lymphocytic infiltrate. Tumor necrosis factor blocker withdrawal associated with topical and systemic corticosteroids induced complete remission of APF in all 3 patients. The expressions of interleukin (IL)-1 beta and its receptors as well as TNF alpha and its receptors were significantly higher in APF than in controls. Also IL-17, leukocyte selectin, and chemokines, such as IL-8, [C-X-C motif] chemokine ligand 1/2/3 (C = cysteine, X = any amino acid), [C-X-C motif] chemokine ligand 16 (C = cysteine, X = any amino acid), and RANTES (regulated on activation, normal T cell expressed and secreted) were significantly overexpressed. Finally, the authors found significant overexpression of both metalloproteinases 2/9 and their inhibitors 1/2.The observation of 3 patients with APF following anti-TNF therapy expands not only the clinical context of APF but also the spectrum of anti-TNF side effects. Overexpression of cytokines/chemokines and molecules amplifying the inflammatory network supports the view that APF is autoinflammatory in origin.
Collapse
Affiliation(s)
- Angelo V Marzano
- From the Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Cà Granda Foundation, Milan, Italy (AVM, ST, EB, CG) and Internal Medicine Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Cà Granda Foundation, Milan, Italy (MC)
| | | | | | | | | |
Collapse
|
67
|
Bonciolini V, Bianchi B, Del Bianco E, Verdelli A, Caproni M. Cutaneous Manifestations of Non-Celiac Gluten Sensitivity: Clinical Histological and Immunopathological Features. Nutrients 2015; 7:7798-805. [PMID: 26389946 PMCID: PMC4586563 DOI: 10.3390/nu7095368] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The dermatological manifestations associated with intestinal diseases are becoming more frequent, especially now when new clinical entities, such as Non-Celiac Gluten Sensitivity (NCGS), are identified. The existence of this new entity is still debated. However, many patients with diagnosed NCGS that present intestinal manifestations have skin lesions that need appropriate characterization. METHODS We involved 17 patients affected by NCGS with non-specific cutaneous manifestations who got much better after a gluten free diet. For a histopathological and immunopathological evaluation, two skin samples from each patient and their clinical data were collected. RESULTS The median age of the 17 enrolled patients affected by NCGS was 36 years and 76% of them were females. On the extensor surfaces of upper and lower limbs in particular, they all presented very itchy dermatological manifestations morphologically similar to eczema, psoriasis or dermatitis herpetiformis. This similarity was also confirmed histologically, but the immunopathological analysis showed the prevalence of deposits of C3 along the dermo-epidermal junction with a microgranular/granular pattern (82%). CONCLUSIONS The exact characterization of new clinical entities such as Cutaneous Gluten Sensitivity and NCGS is an important objective both for diagnostic and therapeutic purposes, since these are patients who actually benefit from a GFD (Gluten Free Diet) and who do not adopt it only for fashion.
Collapse
Affiliation(s)
- Veronica Bonciolini
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo 41, Florence 50125, Italy.
| | - Beatrice Bianchi
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo 41, Florence 50125, Italy.
| | - Elena Del Bianco
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo 41, Florence 50125, Italy.
| | - Alice Verdelli
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo 41, Florence 50125, Italy.
| | - Marzia Caproni
- Director SOS Skin Immunopathology and Rare Dermatological Diseases Unit, 1st Dermatological Clinic ASF-Piero Palagi, Department of Medical and Surgical Critical Care, Section of Dermatology, University of Florence, Viale Michelangiolo 41, Florence 50125, Italy.
| |
Collapse
|
68
|
Lolli E, Saraceno R, Calabrese E, Ascolani M, Scarozza P, Chiricozzi A, Onali S, Petruzziello C, Chimenti S, Pallone F, Biancone L. Psoriasis Phenotype in Inflammatory Bowel Disease: A Case-Control Prospective Study. J Crohns Colitis 2015; 9:699-707. [PMID: 25908719 DOI: 10.1093/ecco-jcc/jjv068] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 04/14/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Whether inflammatory bowel disease [IBD] is associated with specific psoriasis phenotypes is undefined. In a case-control prospective study, we aimed to assess the severity and phenotype of psoriasis in IBD vs matched non-IBD controls with psoriasis [non-IBD]. METHODS From 2011 to 2013, dermatological assessment was performed in all IBD patients showing lesions requiring characterisation. In patients with psoriasis, assessment included: presence, characteristics, and severity. Each IBD patient with psoriasis was matched [gender, ethnicity, age ± 5 years] with one non-IBD patient with psoriasis. STATISTICAL ANALYSIS data were expressed as median [range], chi-square, Student's t test. RESULTS Dermatological assessment was performed in 251 IBD patients [115 females, age 47 [16-85]; IBD duration 9 years [1-46]]: 158 Crohn's disease [CD] [63%], 93 ulcerative colitis [UC] [37%]. Psoriasis was detected in 62 [25%] IBD patients: 36 [58%] CD, 26 UC [42%; p = 0.44]. Clinical characteristics were comparable between IBD patients with or without psoriasis: age 50 [23-72] vs 47 [16-85]; IBD duration 9.5 [1-46] vs 9 [1-41]; p = non-significant]. The non-IBD group included 62 patients with psoriasis: 35 male; age 47 [18-75]. Mild psoriasis was more frequent in IBD vs non-IBD [87% vs 53%; p < 0.0001], whereas moderate and severe psoriasis were more frequent in non-IBD vs IBD [37% vs 13%, p = 0.004; 10% vs 0%; p = 0.036]. Plaque-type psoriasis was the most common phenotype in both IBD and non-IBD [p < 0.0001 vs others phenotypes].The frequency of plaque-type, nail psoriasis and psoriatic arthritis was lower in IBD vs non-IBD [p = 0.008; p < 0.0001; p = 0.006]. Psoriasis occurred after anti-tumour necrosis factor [TNF]α treatment in six CD patients [7%]. CONCLUSIONS Severity and phenotypes of psoriasis may differ between patients with IBD and their matched non-IBD controls.
Collapse
Affiliation(s)
- Elisabetta Lolli
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | - Rosita Saraceno
- Department of Dermatology, University of Rome Tor Vergata, Italy
| | - Emma Calabrese
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | - Marta Ascolani
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | - Patrizio Scarozza
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | | | - Sara Onali
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | | | - Sergio Chimenti
- Department of Dermatology, University of Rome Tor Vergata, Italy
| | - Francesco Pallone
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | - Livia Biancone
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| |
Collapse
|
69
|
Ekwunife CN, Nweke IG, Achusi IB, Ekwunife CU. Ulcerative Colitis Prone to Delayed Diagnosis in a Nigerian Population: Case Series. Ann Med Health Sci Res 2015; 5:311-3. [PMID: 26229722 PMCID: PMC4512126 DOI: 10.4103/2141-9248.160188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Inflammatory bowel disease is an emerging disease burden in the developing world. In Nigeria there is a persisting perception among physicians that it is a very rare disease, and publications on it are sparse. Early manifestations of ulcerative colitis (UC) are therefore likely to be missed at many health institutions. This publication aims to contribute to the growing literature on UC among Nigerians. We present 3 cases of UC that were diagnosed at very late stages. It took a range of 2–7 years for the diagnosis to be made from onset of symptoms. UC was confirmed in the first patient after bowel resection for massive gastrointestinal haemorrhage. The other two had colonoscopy and biopsy for confirmation. An increased awareness about UC is necessary in Nigerian population, because the condition may be commoner than hitherto thought. Provision of colonoscopy services to a wider population will assist in early discovery of this disease.
Collapse
Affiliation(s)
- C N Ekwunife
- Department of Surgery, Federal Medical Centre, Owerri, Imo State, Nigeria
| | - I G Nweke
- Department of Histopathology, Federal Medical Centre, Owerri, Imo State, Nigeria
| | - I B Achusi
- Department of Anatomic Pathology, Federal Staff Hospital Abuja, Nigeria
| | - C U Ekwunife
- Department of Internal Medicine, Federal Medical Centre, Owerri, Imo State, Nigeria
| |
Collapse
|
70
|
Marín-Jiménez I, Gisbert JP, Pérez-Calle JL, García-Sánchez V, Tabernero S, García-Vicuña R, Romero C, Juliá B, Vanaclocha F, Cea-Calvo L. [Two-year incidence of new immune-mediated inflammatory diseases in patients with inflammatory bowel disease: A study in the AQUILES cohort]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 38:569-74. [PMID: 25983283 DOI: 10.1016/j.gastrohep.2015.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To describe the 2-year incidence of new immune-mediated inflammatory diseases (spondylarthritis, uveitis, psoriasis) in the cohort of patients with inflammatory bowel disease (IBD) included in the AQUILES study. MATERIALS AND METHODS Over a 2-year period, 341 patients with IBD (53% women, mean age 40 years) diagnosed with Crohn's disease (60.5%), ulcerative colitis (38.1%) and indeterminate colitis (1.4%) were followed up. New diagnoses made during follow-up were based on reports of the corresponding specialists (rheumatologists, ophthalmologists, and dermatologists). RESULTS A total of 22 new diagnoses of immune-mediated inflammatory diseases were established in 21 patients (cumulative incidence of 6.5%, 95% confidence interval [CI] 3.7-9.2, incidence rate of 26 cases per 10,000 patient-years). Most diagnoses were new cases of spondylarthritis (n=15). The cumulative incidence of new diagnoses of immune-mediated inflammatory diseases was similar in patients with Crohn's disease (5.8%, 95% CI 3.4-9.9) and in patients with ulcerative colitis (7.7%, 95% CI 4.2-13.6). On multivariate analysis, the incidence of new immune-mediated inflammatory diseases was significantly associated with a family history of IBD (odds ratio=3.6, 95% CI 1.4-9.4) and the presence of extraintestinal manifestations of IBD (odds ratio=1.8, 95% CI .7-5.2). CONCLUSIONS In patients with IBD, the incidence of new immune-mediated inflammatory diseases at 2 years of follow-up was 6.5%. These diseases were more frequent in patients with extraintestinal manifestations of IBD and a family history of IBD.
Collapse
Affiliation(s)
| | - Javier P Gisbert
- Departamento de Gastroenterología, Hospital de La Princesa, IP y CIBERehd, Madrid, España
| | - José L Pérez-Calle
- Departamento de Gastroenterología, Hospital Fundación Alcorcón , Madrid, España
| | - Valle García-Sánchez
- Departamento de Gastroenterología, Hospital Reina Sofía-IMIBIC y CIBEREHD, Córdoba, España
| | - Susana Tabernero
- Departamento de Gastroenterología, Hospital Príncipe de Asturias, Madrid, España
| | | | - Cristina Romero
- Departamento de Medical Affairs, Merck Sharp & Dohme de España, Madrid, España
| | - Berta Juliá
- Departamento de Medical Affairs, Merck Sharp & Dohme de España, Madrid, España
| | | | - Luis Cea-Calvo
- Departamento de Medical Affairs, Merck Sharp & Dohme de España, Madrid, España.
| | | |
Collapse
|
71
|
Kamil ZS, Chen T, Ghazarian D. Non-infectious granulomatous conditions of the skin: a clinicopathological approach to diagnosis. J Clin Pathol 2015; 68:982-91. [PMID: 25900338 DOI: 10.1136/jclinpath-2015-203043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 11/03/2022]
Abstract
Granulomatous disorders of the skin are diverse and include infectious and non-infectious conditions. They are a source of confusion to many dermatologists and pathologists, including even the most experienced dermatopathologists. Correlation with clinical picture, serology, microbiology and careful morphological examination is essential for accurate diagnosis. Most cases require ancillary histopathological studies to reach a final diagnosis. This review discusses important non-infectious granulomatous conditions of the skin and presents a practical approach when confronted with such entities.
Collapse
Affiliation(s)
- Zaid Saeed Kamil
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, Ontario, Canada
| | - Tiffany Chen
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Danny Ghazarian
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
72
|
Weizman AV, Huang B, Targan S, Dubinsky M, Fleshner P, Kaur M, Ippoliti A, Panikkath D, Vasiliauskas E, Shih D, McGovern DPB, Melmed GY. Pyoderma Gangrenosum among Patients with Inflammatory Bowel Disease: A Descriptive Cohort Study. J Cutan Med Surg 2015; 19:125-31. [PMID: 25775631 DOI: 10.2310/7750.2014.14053] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a severe extraintestinal manifestation of inflammatory bowel disease (IBD). OBJECTIVE To better characterize PG features and management among an IBD cohort. METHODS Subjects with PG were identified using a large database at a tertiary center. Patient demographics and clinical characteristics were summarized using descriptive statistics. RESULTS Eighty patients with an episode(s) of PG were identified, yielding an overall prevalence of 1.9%. Overall, 93% of patients with PG had some degree of colonic inflammation. Thirty-one (39%) patients required hospitalization for PG. Underlying bowel disease was active at the time of PG episode(s) in 52 (65%) patients. The PG location was variable, with the lower extremity being the most common. Most patients (71.3%) required multiple therapies to achieve PG healing. CONCLUSIONS We describe one of the largest case series of PG among patients with IBD. The variety of treatment strategies used highlights the lack of clear guidelines in managing this complex group of patients.
Collapse
Affiliation(s)
- Adam V Weizman
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Brian Huang
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Marla Dubinsky
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Phillip Fleshner
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Manreet Kaur
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Andrew Ippoliti
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Deepa Panikkath
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Eric Vasiliauskas
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - David Shih
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Dermot P B McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Gil Y Melmed
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| |
Collapse
|
73
|
Zippi M, Corrado C, Pica R, Avallone EV, Cassieri C, De Nitto D, Paoluzi P, Vernia P. Extraintestinal manifestations in a large series of Italian inflammatory bowel disease patients. World J Gastroenterol 2014; 20:17463-17467. [PMID: 25516659 PMCID: PMC4265606 DOI: 10.3748/wjg.v20.i46.17463] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/21/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate prevalence, type and time of onset of extraintestinal manifestations (EIMs) in a series of Italian inflammatory bowel disease (IBD) patients.
METHODS: Data of 811 IBD consecutive patients, first referred to our Centre from 2000 to 2011, were retrospectively evaluated.
RESULTS: Eight hundred and eleven IBD patients (437 M, 374 F) were studied: 595 ulcerative colitis (UC) (73.4%) and 216 Crohn’s disease (CD) (26.6%). Among these, 329 (40.6%) showed EIMs: 210 UC (35.3%) and 119 CD (55.1%) (P < 0.0001). Considering the time of the diagnosis of IBD, 37 EIMs (11.2%) were developed before, 229 (69.6%) after and 63 (19.2%) were simultaneous. The type of EIM were as follows: 240 musculoskeletal (29.6%), in 72 CD patients and in 168 UC (P < 0.0001); 47 mucocutaneous (5.8%), in 26 CD and in 21 UC (P = 0.0049); 26 ocular (3.2%), in 16 CD and in 10 UC (CD 7.4% vs UC 1.7%, P = 0.0093); 6 hepatobiliary (0.8%); 10 endocrinological (1.2%). In particular, with regards to the involvement of the musculoskeletal system, arthritis Type 1 was found in 41 CD (19%) and in 61 UC (10.2%) (P = 0.0012) and Type 2 in 25 CD (11.6%) and in 100 UC (16.8%) (P = 0.0012).
CONCLUSION: Mucocutaneous manifestations, arthritis Type 1 and uveitis were significantly more frequent in CD than UC. The complications of the musculoskeletal system were the mostly observed ones, often with symptoms more severe than intestinal ones, confirming the need for close cooperation with rheumatologists.
Collapse
|
74
|
Marzano AV, Fanoni D, Antiga E, Quaglino P, Caproni M, Crosti C, Meroni PL, Cugno M. Expression of cytokines, chemokines and other effector molecules in two prototypic autoinflammatory skin diseases, pyoderma gangrenosum and Sweet's syndrome. Clin Exp Immunol 2014; 178:48-56. [PMID: 24903614 DOI: 10.1111/cei.12394] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 12/23/2022] Open
Abstract
Pyoderma gangrenosum (PG) and Sweet's syndrome (SS) are two inflammatory skin diseases presenting with painful ulcers and erythematous plaques, respectively; both disorders have a debilitating clinical behaviour and PG is potentially life-threatening. Recently, PG and SS have been included among the autoinflammatory diseases, which are characterized by recurrent episodes of sterile inflammation, without circulating autoantibodies and autoreactive T cells. However, an autoinflammatory pattern clearly supporting this inclusion has never been demonstrated. We studied 16 patients with PG, six with SS and six controls, evaluating, using a sandwich-based protein antibody array method, the expression profile of inflammatory effector molecules in PG, SS and normal skin. The expressions of interleukin (IL)-1 beta and its receptor I were significantly higher in PG (P = 0·0001 for both) and SS (P = 0·004-0·040) than in controls. In PG, chemokines such as IL-8 (P = 0·0001), chemokine (C-X-C motif) ligand (CXCL) 1/2/3 (P = 0·002), CXCL 16 (P = 0·003) and regulated upon activation normal T cell expressed and secreted (RANTES) (P = 0·005) were over-expressed. In SS, IL-8 (P = 0·018), CXCL 1/2/3 (P = 0·006) and CXCL 16 (P = 0·036) but not RANTES were over-expressed, suggesting that chemokine-mediated signals are lower than in PG. Fas/Fas ligand and CD40/CD40 ligand systems were over-expressed in PG (P = 0·0001 for Fas, P = 0·009 for Fas ligand, P = 0·012 for CD40, P = 0·0001 for CD40 ligand), contributing to tissue damage and inflammation, while their role seems to be less significant in SS. Over-expression of cytokines/chemokines and molecules amplifying the inflammatory network supports the view that PG and SS are autoinflammatory diseases. The differences in expression profile of inflammatory effectors between these two disorders may explain the stronger local aggressiveness in PG than SS.
Collapse
Affiliation(s)
- A V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | | | | | | | | |
Collapse
|
75
|
Mann ER, Bernardo D, Ng SC, Rigby RJ, Al-Hassi HO, Landy J, Peake STC, Spranger H, English NR, Thomas LV, Stagg AJ, Knight SC, Hart AL. Human gut dendritic cells drive aberrant gut-specific t-cell responses in ulcerative colitis, characterized by increased IL-4 production and loss of IL-22 and IFNγ. Inflamm Bowel Dis 2014; 20:2299-307. [PMID: 25397892 DOI: 10.1097/mib.0000000000000223] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
: The pathogenesis of inflammatory bowel disease is incompletely understood but results from a dysregulated intestinal immune response to the luminal microbiota. CD4 T cells mediate tissue injury in the inflammatory bowel disease-associated immune response. Dendritic cells (DC) generate primary T-cell responses and mediate intestinal immune tolerance to prevent overt inflammation in response to the gut microbiota. However, most information regarding function of intestinal DC has come from mouse models, and information in humans is scarce. We show here that intestinal DC subsets are skewed in ulcerative colitis (UC) in humans, with a loss of CD103 lymph-node homing DC; this intestinal DC subset preferentially generates regulatory T cells in mice. We show infiltrates of DC negative for myeloid marker CD11c, with enhanced expression of Toll-like receptors for bacterial recognition. After mixed leukocyte reaction, DC from the inflamed UC colon had an enhanced ability to generate gut-specific CD4 T cells with enhanced production of interleukin-4 but a loss of interferon γ and interleukin-22 production. Conditioning intestinal DC with probiotic strain Lactobacillus casei Shirota in UC partially restored their normal function indicated by reduced Toll-like receptor 2/4 expression and restoration of their ability to imprint homing molecules on T cells and to generate interleukin-22 production by stimulated T cells. This study suggests that T-cell dysfunction in UC is driven by DC. T-cell responses can be manipulated indirectly through effects of bacterial conditioning on gut DC with implications for immunomodulatory effects of the commensal microbiota in vivo. Manipulation of DC to allow generation of DC-specific therapy may be beneficial in inflammatory bowel disease.
Collapse
Affiliation(s)
- Elizabeth R Mann
- *Antigen Presentation Research Group, Imperial College London, Northwick Park and St. Mark's Campus, Harrow, United Kingdom; †Gastrointestinal Division, Johns Hopkins University School of Medicine, Baltimore, Maryland; ‡Department of Medicine and Therapeutics, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, State Key Laboratory of Digestive Disease, Chinese University of Hong Kong, Hong Kong, China; §Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom; ‖Department of Gastroenterology, St. Mark's Hospital, North West London Hospitals NHS Trust, Harrow, United Kingdom; ¶Yakult UK Ltd., South Ruislip, United Kingdom; and **Centre for Immunology and Infectious Disease, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
76
|
Shahid S, Myszor M, De Silva A. Pyoderma gangrenosum as a first presentation of inflammatory bowel disease. BMJ Case Rep 2014; 2014:bcr-2014-204853. [PMID: 25385558 DOI: 10.1136/bcr-2014-204853] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Up to 40% of patients with inflammatory bowel disease (IBD) develop an extraintestinal manifestation of the disease with the skin being the most commonly involved organ. Pyoderma gangrenosum (PG), an autoinflammatory non-infectious neutrophilic dermatosis, occurs in 1-2% of patients with IBD. PG can follow a course independent to that of the bowel disease, however, most reported cases describe PG occurring in patients with an established diagnosis of IBD. We present a case of a young patient who presented with axillary skin ulceration, which was subsequently diagnosed as PG. On further investigation for a possible underlying cause, she was found to have Crohn's disease. She had not developed any preceding change in her bowels and did not have abdominal pain; the IBD was diagnosed on endoscopic findings. This case is also unusual for the distribution of the PG lesions that typically occur in the lower limbs.
Collapse
Affiliation(s)
- Shahana Shahid
- Department of Gastroenterology, Royal Berkshire Hospital, Reading, UK
| | - Margaret Myszor
- Department of Gastroenterology, Royal Berkshire Hospital, Reading, UK
| | - Aminda De Silva
- Department of Gastroenterology, Royal Berkshire Hospital, Reading, UK
| |
Collapse
|
77
|
Consider systemic therapy for chronic, refractory or severe cutaneous small-vessel vasculitis. DRUGS & THERAPY PERSPECTIVES 2014. [DOI: 10.1007/s40267-014-0151-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
78
|
González-Moreno J, Ruíz-Ruigomez M, Callejas Rubio JL, Ríos Fernández R, Ortego Centeno N. Pyoderma gangrenosum and systemic lupus erythematosus: a report of five cases and review of the literature. Lupus 2014; 24:130-7. [PMID: 25199808 DOI: 10.1177/0961203314550227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pyoderma gangrenosum (PG) is an uncommon, distinctive cutaneous ulceration which is usually idiopathic, but may be associated with many systemic disorders. The etiopathogenesis of PG is still not well understood. PG is part of the spectrum of the neutrophilic dermatoses and it has been proposed as a prototype of cutaneous autoinflammatory disease. PG usually has a good outcome under immunosuppressive treatment. Although PG has been associated with several systemic diseases, it has rarely been reported in association with systemic lupus erythematosus (SLE). In this article we report five cases of SLE-related PG and review the literature. Our findings support the possible relationship between active SLE and PG, although the mechanism remains unclear. Clinical manifestations, used treatments and outcomes of SLE-related PG do not differ from the described for the general population.
Collapse
Affiliation(s)
- J González-Moreno
- Internal Medicine Department, Hospital Son Llàtzer, Spain Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - M Ruíz-Ruigomez
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - J L Callejas Rubio
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - R Ríos Fernández
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - N Ortego Centeno
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| |
Collapse
|
79
|
Goeser MR, Laniosz V, Wetter DA. A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis. Am J Clin Dermatol 2014; 15:299-306. [PMID: 24756249 DOI: 10.1007/s40257-014-0076-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cutaneous small-vessel vasculitis (CSVV) is a disorder characterized by neutrophilic inflammation predominantly limited to the superficial cutaneous postcapillary venules. CSVV may be idiopathic or may have a defined cause such as infection, medication, connective tissue disease, or malignancy. CSVV may also be associated with extracutaneous disease or systemic vasculitis. The most common clinical presentation of CSVV consists of symmetrically distributed palpable purpura of the lower extremities. In general, lesional skin biopsy samples should be examined with light microscopy and direct immunofluorescence for adult patients with suspected CSVV. A complete history, review of systems, physical examination, and selected laboratory studies also should be performed to assess for inciting causes or extracutaneous involvement of CSVV. Treatment varies and depends on the chronicity of CSVV, the severity of cutaneous involvement, and the presence or absence of both an underlying cause and extracutaneous involvement of CSVV. An isolated episode of CSVV associated with a known inciting factor may be managed by removal or treatment of the trigger, along with symptomatic measures. First-line systemic treatments for chronic, idiopathic CSVV include colchicine or dapsone, used singly or in combination. Recurrent, chronic, or severely symptomatic CSVV that does not respond to the aforementioned therapies may require initiation of an immunosuppressive agent such as azathioprine, mycophenolate mofetil, methotrexate, cyclosporine, or rituximab.
Collapse
|
80
|
Failure of sublesional infliximab injection for refractory parastomal pyoderma gangrenosum in a patient with Crohn's disease. Tech Coloproctol 2014; 18:965-6. [PMID: 24965074 DOI: 10.1007/s10151-014-1192-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
|