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Paris C, Lesort C, Kanitakis J, Danset M. Extra-intestinal manifestation of Crohn's disease: Umbilical lesion successfully treated with intralesional corticosteroids. Ann Dermatol Venereol 2024; 151:103299. [PMID: 39043020 DOI: 10.1016/j.annder.2024.103299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/25/2024] [Accepted: 05/14/2024] [Indexed: 07/25/2024]
Affiliation(s)
- C Paris
- Dermatology Department, Edouard Herriot Hospital, Lyon, France.
| | - C Lesort
- Dermatology Department, Edouard Herriot Hospital, Lyon, France
| | - J Kanitakis
- Dermatology Department, Edouard Herriot Hospital, Lyon, France; Pathology Department, Lyon Sud Hospital Centre, Pierre Bénite, France
| | - M Danset
- Dermatology Department, Edouard Herriot Hospital, Lyon, France
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2
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McKay GE, Liu L, Shaw KS, Shakshouk H, Murphy MJ, Damsky W, Ortega-Loayza AG, Caplan AS, Arkin LM, Shields BE. Pediatric cutaneous Crohn disease: A case series of 89 patients and review. Pediatr Dermatol 2024. [PMID: 39011834 DOI: 10.1111/pde.15689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 06/16/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Cutaneous (or "Metastatic") Crohn disease (CCD) is a rare and underrecognized disease characterized by cutaneous granulomatous inflammation. We describe patient demographics, clinical characteristics, histology, and treatment of 89 pediatric cases of CCD, including 78 previously reported and 11 new cases seen at four academic institutions. We emphasize the efficacy of biologic mono- and dual therapy. METHODS PubMed identified cases using keywords including "metastatic Crohn disease" and "cutaneous Crohn disease". Patients were identified by retrospective review of the electronic health record including histopathologic diagnosis consistent with CCD. Chart review collected demographic, clinical, and histologic data. RESULTS Most pediatric patients with CCD are male 55% (49/89), present with edema (73/89, 82%) and erythema (47/89, 53%) of the genitals (33/49, 67%), and have intestinal Crohn disease (69/89, 78%). Oral corticosteroids (53/75, 71%) and metronidazole (29/75, 39%) are the most frequently prescribed medications. Of the 17 patients treated with tumor necrosis factor (TNF)-blockade, 94% (16/17) had partial or total clearance. Ustekinumab resulted in clearance of cutaneous disease in two patients (2/3, 67%) and partial clearance in one patient (1/3, 33%). Two cases achieved total clearance with the use of dual biologic therapy defined as the use of two biologic therapies with differing mechanisms of action or the use of a biologic therapy and small molecule inhibitor. CONCLUSIONS TNF blockade is an effective treatment for pediatric CCD, and interleukin-12/23 inhibitors may be similarly effective. Consideration of dual biologic therapy may be useful in pediatric patients requiring discordant therapies for their intestinal and cutaneous CD.
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Affiliation(s)
- Grace E McKay
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lynn Liu
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Katharina S Shaw
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hadir Shakshouk
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Michael J Murphy
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
| | - William Damsky
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Avrom S Caplan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Bridget E Shields
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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3
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Yi LG, Valluri AP, Rincon JD, Raghavan S, Zlotoff BJ. Violaceous papules on the limbs of a 10-year-old girl. Pediatr Dermatol 2024; 41:741-743. [PMID: 38444100 DOI: 10.1111/pde.15573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Lauren G Yi
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Anisha P Valluri
- Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia, USA
| | - Juanita Duran Rincon
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Shyam Raghavan
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Barrett J Zlotoff
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
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4
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Zaino ML, Pixley JN, Feldman SR, Pichardo RO. Vulvar Crohn's disease: a retrospective chart review at a single academic institution. Arch Dermatol Res 2024; 316:439. [PMID: 38941029 DOI: 10.1007/s00403-024-03172-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Mallory L Zaino
- Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA
| | - Jessica N Pixley
- Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA.
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rita O Pichardo
- Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA
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5
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Elger T, Loibl J, Buechler C, Haferkamp S, Werner J, Drexler K, Hohenleutner U, Guelow K, Kunst C, Kandulski A, Goeggelmann P, Mueller M, Tews HC. Fistulising skin metastases in Crohn's disease: a case report and review of the literature. J Med Case Rep 2024; 18:252. [PMID: 38762485 PMCID: PMC11102623 DOI: 10.1186/s13256-024-04569-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/10/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Metastatic Crohn's disease is a rare disorder characterized by various granulomatous skin lesions that occur independently of gastrointestinal tract involvement. However, currently there is no standardized care or specific treatment. Therapeutic approaches include immunosuppressive agents, such as corticosteroids, azathioprine, and monoclonal antibodies targeting inflammatory cytokines like tumor necrosis factor (TNF). CASE PRESENTATION We present a case of a 29-year-old western European woman with significant blind ending abdominal subcutaneous fistulas and abscesses, who sought evaluation in the dermatology department. Histological examination revealed multiple epithelioid cell granulomas. There was no evidence of infectious or rheumatologic diseases such as sarcoidosis. The tentative diagnosis was metastatic Crohn's disease, which was not related to an intestinal manifestation of the disease. The patient responded to infliximab but had to discontinue it due to an allergic reaction. Subsequent adalimumab treatment failed to induce clinical remission; thus, therapy was switched to ustekinumab, resulting in a positive response. Written informed consent for publication of their clinical details and clinical images was obtained from the patient. For our study more than 1600 publications were screened for cases of metastatic Crohn's disease on PubMed database. 59 case reports with 171 patients were included in the analysis and evaluated for localization, diagnostic and therapeutic approaches, and complications and were summarized in this review. CONCLUSION The successful ustekinumab treatment of a patient with metastatic Crohn's disease underscores the potential of this minimally investigated therapeutic option, highlighting the need for future treatment guidelines given the increasing prevalence of such cases.
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Affiliation(s)
- Tanja Elger
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Johanna Loibl
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christa Buechler
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Jens Werner
- Department of Visceral Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Konstantin Drexler
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Ulrich Hohenleutner
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Karsten Guelow
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Claudia Kunst
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Arne Kandulski
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Pia Goeggelmann
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Martina Mueller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Hauke Christian Tews
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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6
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Raman LG, AbdullGaffar B. Metastatic Crohn disease revealing vascular embolization: Report of two cases. J Cutan Pathol 2023; 50:929-932. [PMID: 37622172 DOI: 10.1111/cup.14521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
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7
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Pereira AS, Coutinho I. A Challenging Case of Metastatic Crohn's Disease Without Gastrointestinal Manifestations. Cureus 2023; 15:e45791. [PMID: 37872941 PMCID: PMC10590629 DOI: 10.7759/cureus.45791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
Metastatic Crohn's disease (MCD) is a rare cutaneous manifestation of Crohn's Disease (CD), defined as non-caseating, granulomatous skin lesions non-contiguous with the gastrointestinal (GI) tract. Most patients with MCD either have concomitant classic manifestations of CD or develop them within a few months to years. We report a case of MCD without known involvement of the GI tract, after more than three years from diagnosis. After failure or intolerance to several conventional treatments, including oral corticosteroids and azathioprine, adalimumab was initiated with a good response. Diagnosis of cutaneous CD is made by a combination of clinical and histopathological findings. Therapeutic options include topical, intralesional, and systemic corticosteroids as well as topical and systemic immunosuppressants and immunomodulators. Surgical excision may be considered for refractory cases.
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Affiliation(s)
- Ana S Pereira
- Dermatology, Coimbra Hospital and University Center, Coimbra, PRT
| | - Inês Coutinho
- Dermatology, Coimbra Hospital and University Center, Coimbra, PRT
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8
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Ferreira de Castro L, Gomes R, Sá DC, Fernandes E, Lima R, Tavares M. Metastatic Crohn's disease in paediatrics: Vulvar lesions as the first clinical presentation. J Paediatr Child Health 2023; 59:1092-1094. [PMID: 37539968 DOI: 10.1111/jpc.16471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/20/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Luís Ferreira de Castro
- Gynaecology Department, Centro Materno Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto (CMIN-CHUPorto), Porto, Portugal
| | - Rita Gomes
- Paediatrics Department, Centro Materno Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto (CMIN-CHUPorto), Porto, Portugal
| | - Diogo Carvalho Sá
- Pathology Department, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - Eugénia Fernandes
- Gynaecology Department, Centro Materno Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto (CMIN-CHUPorto), Porto, Portugal
| | - Rosa Lima
- Gastroenterology Unit, Paediatrics Department, Centro Materno Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto (CMIN-CHUPorto), Porto, Portugal
| | - Marta Tavares
- Gastroenterology Unit, Paediatrics Department, Centro Materno Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto (CMIN-CHUPorto), Porto, Portugal
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9
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Alotaibi HM, Fathaddin AA, AlMutairi HM, Barakeh MM. Metastatic Crohn's Disease in External Genitalia With Good Outcome on Adalimumab: A Rare Case of a Saudi Female and a Short Review. Cureus 2023; 15:e43380. [PMID: 37700991 PMCID: PMC10494988 DOI: 10.7759/cureus.43380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/14/2023] Open
Abstract
Crohn's disease (CD), an inflammatory bowel disease that involves the gastrointestinal tract, is observed in daily hospital practice. On the other hand, metastatic Crohn's disease (MCD) is a rare entity in which cutaneous lesions are found in regions apart from the digestive system. This article describes a rare case of cutaneous CD in a Saudi female, which manifested initially as vulvar and perianal skin lesions. The diagnosis was proven by skin biopsy, and adalimumab offered effective treatment. Although cutaneous MCD is rare, it is an important cutaneous manifestation, as early detection creates the possibility of accessing effective management.
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10
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Beysens S, Wellens J, De Hertogh G, Van Laethem A, Sabino J, Hillary T, Vermeire S. Managing metastatic Crohn's disease: a single center experience, review of the current evidence, and treatment algorithm. Scand J Gastroenterol 2023; 58:1122-1130. [PMID: 37178009 DOI: 10.1080/00365521.2023.2209689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Crohn's disease (CD) is an inflammatory bowel disease (IBD) that, besides gastrointestinal symptoms, may encompass extra-intestinal symptoms, such as dermatological manifestations. Of those, metastatic CD (MCD) is a rare extra-intestinal manifestation for which the management is uncertain. METHODS We conducted a retrospective case series of patients with MCD seen at the University hospital Leuven, Belgium, combined with an overview of the recent literature. Electronic medical records were searched from January 2003 till April 2022. For the literature search, Medline, Embase, Trip Database, and The Cochrane Library were searched from inception to April 1, 2022. RESULTS A total of 11 patients with MCD were retrieved. In all cases noncaseating granulomatous inflammation was found on skin biopsies. Two adults and one child were diagnosed with MCD prior to their diagnosis of CD. Seven patients were treated with steroids (intralesional, topical or systemic). Six patients needed a biological therapy to treat MCD. Surgical excision was performed in three patients. All patients reported a successful outcome and most cases achieved remission. The literature search yielded 53 articles, including three reviews, three systematic reviews, 30 case reports and six case series. A treatment algorithm was generated based on literature and multidisciplinary discussion. CONCLUSION MCD remains a rare entity and diagnosis is often difficult. A multidisciplinary approach including skin biopsy is necessary to diagnose and treat MCD efficiently. Outcome is generally favorable, and lesions respond well to steroids and biologicals. We propose a treatment algorithm based on the available evidence and multidisciplinary discussion.
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Affiliation(s)
- S Beysens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - J Wellens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
| | - G De Hertogh
- KU Leuven Department of Imaging and Pathology, Translational Cell and Tissue Research Unit, Leuven, Belgium
| | - A Van Laethem
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - J Sabino
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
| | - T Hillary
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - S Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
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11
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Hrin ML, Williams J, Bowers NL, Ahn CS, Strowd LC. Methotrexate for recalcitrant cutaneous Crohn's disease: a dermatology-based case series with emphasis on outcomes. Int J Dermatol 2023; 62:e274-e276. [PMID: 36040019 DOI: 10.1111/ijd.16417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Matthew L Hrin
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Josiah Williams
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nathan L Bowers
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christine S Ahn
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lindsay C Strowd
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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12
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Ganesh Kumar N, Chan MP, Kung TA. A Cutaneous Manifestation of Crohn's Disease. Am Surg 2023; 89:1039-1040. [PMID: 33295201 DOI: 10.1177/0003134820956330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nishant Ganesh Kumar
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Theodore A Kung
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
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13
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Dev A, Chatterjee D, Vinay K. Nonhealing Genital Ulcers as Clue to a Multisystem Disease. JAMA Dermatol 2023; 159:211-212. [PMID: 36630105 DOI: 10.1001/jamadermatol.2022.5863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A female patient in her late 40s presented with a 3-year history of nonhealing ulcers in her groin and axillae. What is your diagnosis?
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Affiliation(s)
- Anubha Dev
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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14
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Refractory metastatic Crohn's disease responsive to ustekinumab dose intensification. JAAD Case Rep 2022; 32:65-67. [PMID: 36654767 PMCID: PMC9841365 DOI: 10.1016/j.jdcr.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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15
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Ling HY, Lim SYD, Lim HLJ. Unilateral vulval edema as the presenting cutaneous manifestation of Crohn's disease. Int J Gynaecol Obstet 2022; 159:983-984. [PMID: 35844044 DOI: 10.1002/ijgo.14352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 11/12/2022]
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16
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Kinberger M, Bonnekoh H, Dilling A, Meier K. [Granulomatous dermatoses]. Z Rheumatol 2022; 81:577-586. [PMID: 35854155 DOI: 10.1007/s00393-022-01239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/26/2022]
Abstract
The group of granulomatous dermatoses refers to a multitude of clinically different diseases, which are characterized by a histopathologically similar pattern of inflammation. The cause of granulomatous inflammatory reactions can be infections and also noninfectious stimuli, such as cell disintegration or foreign bodies. The aim of this immunological defence reaction is encapsulation in order to prevent further spread and delimitation from healthy tissue. This is histologically expressed as a granuloma in the sense of a circumscribed aggregation of histiocytes and multinucleated giant cells mostly in dermal connective tissue. The following can be histologically differentiated: sarcoid granuloma characterized by a sparse lymphocytic inflammatory infiltrate and tuberculous granuloma with central necrosis and denser lymphocytic inflammatory infiltrate. Neutrophilic granulocytes together with macrophages occur in suppurative granulomas and palisaded granulomas are characterized by peripherally arrayed macrophages.
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Affiliation(s)
- Maria Kinberger
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Hanna Bonnekoh
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Amrei Dilling
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Kuang AG, Bahdi F, Shukla R. Unusual Skin Ulcerations in a Patient With Hematochezia. Gastroenterology 2022; 163:e7-e9. [PMID: 34958761 DOI: 10.1053/j.gastro.2021.12.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Andrew G Kuang
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Firas Bahdi
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Richa Shukla
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas.
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18
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Patel BM, Ramos Rivers C, Koutroumpakis F, Ahsan M, Dueker J, Hashash J, Johnston E, Barrie A, Harrison J, Schwartz M, Babichenko D, Tang G, Binion D. Ustekinumab-Induced Remission of Two Cases of Refractory Cutaneous Crohn's Disease. Inflamm Bowel Dis 2021; 27:e124. [PMID: 33999193 DOI: 10.1093/ibd/izab115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Bansri M Patel
- University of Pittsburgh School of Medicine, Pittsburgh, Pennyslvania, USA
| | - Claudia Ramos Rivers
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennyslvania, USA
| | - Filippos Koutroumpakis
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennyslvania, USA
| | - Maaz Ahsan
- University of Pittsburgh School of Medicine, Pittsburgh, Pennyslvania, USA
| | - Jeffrey Dueker
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennyslvania, USA
| | - Jana Hashash
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennyslvania, USA
| | - Elyse Johnston
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennyslvania, USA
| | - Arthur Barrie
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennyslvania, USA
| | - Janet Harrison
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennyslvania, USA
| | - Marc Schwartz
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennyslvania, USA
| | - Dmitriy Babichenko
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennyslvania, USA
| | - Gong Tang
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennyslvania, USA
| | - David Binion
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennyslvania, USA
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19
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Genital and Intertriginous Rashes Refractory to Antimicrobial Treatments: Have You Thought about Crohn's Disease? Case Rep Pediatr 2021; 2021:5578810. [PMID: 34336339 PMCID: PMC8324389 DOI: 10.1155/2021/5578810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Crohn's disease is an inflammatory bowel disease that can have multiple extraintestinal manifestations and can develop prior to, following, or simultaneously with gastrointestinal tract involvement (Aberumand et al. (2017), Georgious et al. (2006), Larsen et al. (2010), Levine and Burakoff (2011), Louis et al. (2018)). This report examines the case of a 16-year-old male with a rash of the genital, intergluteal, and inguinal regions refractory to antimicrobial treatments suspicious for an extraintestinal manifestation of Crohn's disease. The patient was diagnosed with inflammatory, nonfistulizing colonic Crohn's disease following presentation with gastrointestinal symptoms including abdominal pain and bloody stools 6 months after the onset of the rash. The genital lesions resolved after starting treatment for Crohn's disease with adalimumab.
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20
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Ickrath F, Stoevesandt J, Schulmeyer L, Glatzel C, Goebeler M, Kerstan A. Metastatischer Morbus Crohn: eine unterschätzte Entität. J Dtsch Dermatol Ges 2021; 19:973-982. [PMID: 34288476 DOI: 10.1111/ddg.14447_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Franziska Ickrath
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Johanna Stoevesandt
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Lena Schulmeyer
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Caroline Glatzel
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Matthias Goebeler
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Andreas Kerstan
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Germany
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21
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Hong EH, Jung JW, Park EJ, Kim KJ, Kim KH. Crohn's Disease with Cutaneous Polyarteritis Nodosa in a Child: A Case Report. Ann Dermatol 2021; 33:365-368. [PMID: 34341639 PMCID: PMC8273316 DOI: 10.5021/ad.2021.33.4.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 11/23/2022] Open
Abstract
A 10-year-old boy presented with a 1-day history of multiple painful erythematous skin lesions on his upper and lower extremities. He was admitted to the Department of Pediatrics with persistent right lower abdominal pain and diarrhea. Punch biopsy of a skin lesion on his lower leg showed necrotizing granulomatous vasculitis with septal panniculitis consistent with polyarteritis nodosa, and our differential diagnosis included cutaneous manifestations of Croh's disease. Abdominal ultrasonography revealed distended colonic loops suggestive of inflammatory bowel disease. Upper and lower gastrointestinal endoscopy revealed lesions involving the duodenum, cecum, colon, and rectum. He developed multiple perianal fistulas during hospitalization. Additional laboratory tests revealed positive results for anti-saccharomyces cerevisiae and antinuclear antibodies. Based on his clinical presentation and laboratory findings, he was diagnosed with Crohn's disease associated with cutaneous polyarteritis nodosa. We report a rare case of a child who presented with cutaneous polyarteritis nodosa as an extraintestinal manifestation of Crohn's disease.
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Affiliation(s)
- Eun Hye Hong
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Joon Woo Jung
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Joong Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Ho Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
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22
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A Verrucous Plaque With Linear Fissures in a Patient With Crohn's Disease: Answer. Am J Dermatopathol 2021; 43:461-463. [PMID: 34006733 DOI: 10.1097/dad.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Ickrath F, Stoevesandt J, Schulmeyer L, Glatzel C, Goebeler M, Kerstan A. Metastatic Crohn's disease: an underestimated entity. J Dtsch Dermatol Ges 2021; 19:973-982. [PMID: 33960613 DOI: 10.1111/ddg.14447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/28/2021] [Indexed: 11/30/2022]
Abstract
Cutaneous metastatic Crohn's disease (MCD) is a rare but challenging dermatologic manifestation of Crohn's disease. It is histologically defined as the presence of non-caseating granulomas at skin sites separated from and non-contiguous to the gastrointestinal tract. Cutaneous metastatic Crohn's disease should be distinguished from the much more frequent contiguous cutaneous manifestations of Crohn's disease that present at perianal or, less common, peristomal sites with direct extension from the intestine to the adjacent skin. Versatile clinical presentation and the fact that occurrence can predate the initial diagnosis of Crohn's disease may lead to misdiagnosis, delayed treatment and underreporting. As case numbers are small and randomized controlled studies on management are lacking, the therapeutic approach remains challenging and is often unsatisfactory. We here performed a systematic literature search identifying 264 published pediatric and adult cases of MCD and additionally report three of our own cases. Our review summarizes clinical characteristics, putative etiopathology, histologic findings, differential diagnoses and treatment options for MCD.
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Affiliation(s)
- Franziska Ickrath
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Johanna Stoevesandt
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Lena Schulmeyer
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Glatzel
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Kerstan
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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24
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Metastatic Crohn Disease: A Clinicohistological Appraisal From a Tertiary Care Center in India. Am J Dermatopathol 2021; 42:506-512. [PMID: 31693502 DOI: 10.1097/dad.0000000000001543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Granulomatous dermatitis due to noncontiguous involvement of Crohn disease (CD) of the gut has been described as metastatic CD (MCD). MCD is the rarest form of cutaneous manifestations of CD. This study aims to analyze the clinicohistological features of MCD in a tertiary care center of India. MATERIALS AND METHODS A retrospective review of patients diagnosed clinically and histologically with MCD over past 5 years was performed. Data on cutaneous features, histological findings, and response to treatment were collected. RESULTS Twelve patients (3 men and 9 women) with a mean age of 29 years were identified. All women had vulval involvement in the form of edema (80%), ulceration (60%), and fistula (20%). Among the 3 men, 2 had perineal and scrotal swelling and ulcer, whereas the third patient presented with leg ulcer. Intestinal CD was already diagnosed in 50% patients (5/10) at cutaneous presentation, whereas it was diagnosed subsequently in 30% (3/10) cases. Histological examination revealed nonnecrotizing granulomatous inflammation in the dermis in 11 patients (92%). Additional histological features included eosinophilic infiltrate (58%), panniculitis (33%), and vasculitis (33%). The patients were treated with various combinations of oral prednisolone, metronidazole, minocycline, azathioprine, and subcutaneous adalimumab with partial relief. CONCLUSION MCD shows a wide spectrum of clinical presentation, with anogenital involvement being the most common. Histology reveals nonnecrotizing granulomas in the dermis in majority of the cases. The diagnosis is extremely challenging in patients without gastrointestinal involvement at presentation, and thus, a high index of suspicion is imperative.
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25
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Gomolin A, Zargham H, Sant'Anna AM, Lovett A. Vulvar swelling and the timely diagnosis of Crohn's disease: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211008627. [PMID: 33889413 PMCID: PMC8040378 DOI: 10.1177/2050313x211008627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Children with vulvar swelling often present to multiple physicians and face a prolonged period of ambiguity and extraneous treatments. Here, we report a case of an 8-year-old girl who presented to the dermatology clinic with a 2-month history of vulvar swelling and was ultimately diagnosed with Crohn’s disease. Although extra-intestinal manifestations are common in inflammatory bowel diseases, they rarely present before an existing diagnosis. This report highlights this potential early manifestation and demonstrates how timely diagnosis leads to improved outcomes for patients, their families, and healthcare systems.
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Affiliation(s)
| | | | - Ana Maria Sant'Anna
- McGill University, Montreal, QC, Canada.,Division of Gastroenterology and Nutrition, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Audrey Lovett
- McGill University, Montreal, QC, Canada.,Division of Allergy, Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
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26
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Ballester Sánchez R, Sanchís Sánchez C, Rodrigo Nicolás B, Valcuende Cavero F. Metastatic Crohn Disease Treated With Ustekinumab. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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27
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Yen CY, Chen YH, Juan CK, Hsu CH. Successful treatment of metastatic Crohn disease with dapsone. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_51_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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28
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Imhof RL, Tollefson MM. Crohn Disease-Associated Genital Edema. JAMA Dermatol 2020; 156:334. [PMID: 31851286 DOI: 10.1001/jamadermatol.2019.3504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Reese L Imhof
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Megha M Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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29
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Ballester Sánchez R, Sanchís Sánchez C, Rodrigo Nicolás B, Valcuende Cavero F. Metastatic Crohn Disease Treated With Ustekinumab. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:182-183. [PMID: 33075293 DOI: 10.1016/j.ad.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rosa Ballester Sánchez
- Servicio de Dermatología. Hospital Universitari de La Plana, Villarreal, Castellón, España.
| | - Celia Sanchís Sánchez
- Servicio de Dermatología. Hospital Universitari de La Plana, Villarreal, Castellón, España
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30
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Shields BE, Richardson C, Arkin L, Kornik R. Vulvar Crohn disease: Diagnostic challenges and approach to therapy. Int J Womens Dermatol 2020; 6:390-394. [PMID: 33898705 PMCID: PMC8060678 DOI: 10.1016/j.ijwd.2020.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 12/16/2022] Open
Abstract
Crohn disease (CD) may be complicated by contiguous, metastatic, or associated inflammatory cutaneous lesions. Vulvar CD is a rare phenomenon characterized by granulomatous genital inflammation that occurs independently from fistulizing CD. Left untreated, vulvar CD can result in debilitating lymphedema, disfiguring anatomic changes, secondary abscesses, cellulitis, and squamous cell carcinoma. We present a series of cases to highlight the clinical presentation of vulvar CD, the diagnostic testing required to distinguish complicating conditions, the asynchronous courses of skin and intestinal disease, and the complexities in the management of this disease and associated conditions. We review our multidisciplinary approach to care, aimed at reducing morbidity and improving patient quality of life.
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Affiliation(s)
- Bridget E Shields
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Catherine Richardson
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, United States
| | - Lisa Arkin
- Department of Dermatology, University of Wisconsin, School of Medicine and Public Health, Madison, WI, United States
| | - Rachel Kornik
- Department of Dermatology, University of Wisconsin, School of Medicine and Public Health, Madison, WI, United States
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31
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El-Enany G, Nagui N, Nada H, El Ghanam O, Kadry N, Abdel-Halim MRE, Elbendary A. Swollen fissured vulva. Clin Exp Dermatol 2020; 45:1080-1083. [PMID: 32852784 DOI: 10.1111/ced.14403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Affiliation(s)
- G El-Enany
- Department of Dermatology, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Egypt
| | - N Nagui
- Department of Dermatology, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Egypt
| | - H Nada
- Department of Dermatology, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Egypt
| | - O El Ghanam
- Department of Dermatology, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Egypt
| | - N Kadry
- Department of Dermatology, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Egypt
| | - M R E Abdel-Halim
- Department of Dermatology, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Egypt
| | - A Elbendary
- Department of Dermatology, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Egypt
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32
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Lansdorp CA, Buskens CJ, Gecse KB, D’Haens GRAM, Van Hulst RA. Wound healing of metastatic perineal Crohn's disease using hyperbaric oxygen therapy: A case series. United European Gastroenterol J 2020; 8:820-827. [PMID: 32529922 PMCID: PMC7435003 DOI: 10.1177/2050640620934915] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Metastatic Crohn's disease (CD) is a rare manifestation of CD. It involves inflammatory skin lesions with histopathological findings (granulomas) similar to CD, without connection to the gastrointestinal tract. Hyperbaric oxygen therapy (HBO) has been suggested as a possible treatment option. OBJECTIVE This study aimed to identify and treat a consecutive series of patients with biopsy-proven metastatic CD and monitor wound healing using prospectively acquired outcomes. METHODS Pathology results of all patients with ongoing perineal wound-healing problems after proctectomy between 2005 and 2018 at the Amsterdam University Medical Centre were assessed for metastatic CD. Patients with a biopsy-proven diagnosis of perineal metastatic CD were offered HBO (40 daily sessions of 100% oxygen at 2.4 atmosphere absolute). Wound healing was monitored using photographs and standardised questionnaires (the Inflammatory Bowel Disease Questionnaire, EuroQol Visual Analogue Scale and the Female Sexual Function Index) at baseline and 1 and 3 months after HBO. RESULTS Out of 13 patients in the cohort with persisting perineal wounds after proctectomy, six (46%) had biopsy results consistent with metastatic CD. Of these, three accepted treatment with HBO. All three patients were female. One patient had complete healing of her perineal wound; another patient showed initial improvement but had a flare of luminal and perineal disease at the 3-month follow-up. The third patient showed improvement solely in the questionnaires, with higher scores on all three questionnaires. CONCLUSION A high rate of metastatic CD was found in patients with ongoing wound-healing problems after proctectomy, implying that the disease might not be as rare in these selected patients as previously thought. HBO might be beneficial in the treatment of metastatic CD.
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Affiliation(s)
- Corine A Lansdorp
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Christianne J Buskens
- Department of Surgery, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Geert RAM D’Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Rob A Van Hulst
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
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33
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Stoleru G, Robbins G, Papadimitriou JC, Wong U. Rapid Resolution of Vulvar Crohn's Disease With Ustekinumab. ACG Case Rep J 2020; 7:e00452. [PMID: 33195730 PMCID: PMC7655089 DOI: 10.14309/crj.0000000000000452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 11/17/2022] Open
Abstract
In the evaluation of patients with inflammatory bowel disease, assessment of extraintestinal manifestations of disease is integral to clinical management. The patient described in this case is a 24-year-old woman with a history of inflammatory colonic Crohn's disease (CD) who presented to the hospital with one week of vaginal pain and swelling. Initial assessment focused on infectious etiologies, though final diagnosis of vulvar CD was made on biopsy. Clinical course and treatment of vulvar CD are poorly defined in existing literature. This case highlights the multidisciplinary management of inflammatory bowel disease patients and successful treatment of a rare extraintestinal manifestation with anti-interleukin 12/23 therapy.
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Affiliation(s)
- Gianna Stoleru
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD
| | - Gordon Robbins
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, MD
| | | | - Uni Wong
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, MD
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34
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Streight KL, Braun TL, Lowe N, Kim SJ. A Rare Clinical Presentation of Metastatic Crohn's Disease. Cureus 2020; 12:e8285. [PMID: 32467818 PMCID: PMC7250390 DOI: 10.7759/cureus.8285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 31-year-old female with a history of systemic lupus erythematous, IgA nephropathy, and psoriasis presented with a one-month history of a painful, pruritic rash under the bilateral breasts and in the genital region. Cutaneous examination revealed a large, tender ulcer under the left breast with a shiny erythematous base and peripheral hypertrophic changes. Small ulcers were present on the bilateral inguinal folds, and the labia majora were edematous with multiple erythematous papules. Histological examination of the left breast revealed ulceration with granulomatous dermatitis, consistent with a diagnosis of metastatic Crohn's disease. Metastatic Crohn's disease is a rare cutaneous manifestation of Crohn's disease characterized by non-caseating granulomas in regions non-contiguous with the gastrointestinal tract. At the time of diagnosis, our patient reported no gastrointestinal symptoms aside from occasional blood-streaked stools from hemorrhoids. This case demonstrates the importance of considering the disease when a patient presents with intertriginous or genital lesions, even in the absence of systemic manifestations.
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Affiliation(s)
| | - Tara L Braun
- Dermatology, Baylor College of Medicine, Houston, USA
| | - Nicholas Lowe
- Dermatology, Baylor College of Medicine, Houston, USA
| | - Soo Jung Kim
- Dermatology, Baylor College of Medicine, Houston, USA
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35
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Lee MH, Lubner MG, Peebles JK, Hinshaw MA, Menias CO, Levine MS, Pickhardt PJ. Clinical, Imaging, and Pathologic Features of Conditions with Combined Esophageal and Cutaneous Manifestations. Radiographics 2019; 39:1411-1434. [PMID: 31419189 DOI: 10.1148/rg.2019190052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A variety of clinically significant conditions can affect both the esophagus and the skin. Esophageal and cutaneous manifestations may directly reflect the underlying disease process, as in infections such as herpes simplex virus, bullous diseases such as epidermolysis bullosa and mucous membrane pemphigoid, connective tissue diseases such as systemic sclerosis, and inflammatory diseases such as lichen planus. Alternatively, esophageal and cutaneous findings may result from conditions that are closely associated with and potentially pathognomonic for but distinct from the underlying disease process, as in genetic diseases such as Cowden syndrome or paraneoplastic syndromes such as acrokeratosis paraneoplastica. Other diseases such as Crohn disease may have cutaneous manifestations that directly reflect the same underlying inflammatory process that affects the gastrointestinal tract or cutaneous manifestations that represent reactive or associated conditions distinct from the underlying inflammatory process. The cutaneous manifestations of disease may precede, coincide with, or follow the esophageal manifestations of disease. The authors present the characteristic clinical features and imaging findings associated with common and uncommon conditions that have esophageal and cutaneous manifestations. Each condition is presented with a brief overview, discussion of salient clinical and cutaneous manifestations, and description of the typical esophageal imaging findings, with particular attention to implications for diagnosis, prognosis, and treatment. Recognition of potential associations between cutaneous lesions and esophageal imaging findings is important for establishing a specific diagnosis or generating a meaningful differential diagnosis.
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Affiliation(s)
- Matthew H Lee
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Meghan G Lubner
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - J Klint Peebles
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Molly A Hinshaw
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Christine O Menias
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Marc S Levine
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Perry J Pickhardt
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
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36
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Iida T, Hida T, Matsuura M, Uhara H, Nakase H. Current clinical issue of skin lesions in patients with inflammatory bowel disease. Clin J Gastroenterol 2019; 12:501-510. [PMID: 30838512 DOI: 10.1007/s12328-019-00958-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/28/2019] [Indexed: 02/08/2023]
Abstract
Inflammatory bowel disease (IBD) is associated with a number of extraintestinal complications, including skin lesions. Most reports have shown that skin lesions are found in 10-15% of IBD cases, although this depends on the definition of skin lesions. The representative skin lesions in patients with IBD are erythema nodosum, pyoderma gangrenosum, Sweet's syndrome, and so on. These lesions are often associated with IBD progression, and intestinal lesions in particular require appropriate treatment. Recently, another clinical issue regarding skin lesions in patients with IBD, a so-called paradoxical reaction, during the treatment with anti-tumor necrosis factor (TNF)-α agents has emerged. These reactions are termed paradoxical reactions because the skin lesions sometimes resemble psoriasis, although the anti-TNF-α agents have been historically used to treat psoriasis. Paradoxical reactions are reportedly found in approximately 5-10% of patients using anti-TNF-α agents and are no longer rare. Now that the use of biologics is at its culmination, reports regarding paradoxical reactions are predicted to increase in number; thus, we must recognize skin lesions with IBD patients including this type of adverse events and manage them appropriately while consulting with dermatologists.
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Affiliation(s)
- Tomoya Iida
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tokimasa Hida
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Minoru Matsuura
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hisashi Uhara
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan.
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Kyriakou G, Gkermpesi M, Thomopoulos K, Marangos M, Georgiou S. Metastatic vulvar Crohn’s disease preceding intestinal manifestations: a case report and short review. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2019. [DOI: 10.15570/actaapa.2019.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Riegert M, Peebles JK, O'Connell DM, Arkin LM. Visual Diagnosis: A 7-year-old Girl with Labial Edema and Decreased Growth Velocity. Pediatr Rev 2018; 39:e57-e59. [PMID: 30504258 DOI: 10.1542/pir.2017-0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Maureen Riegert
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Daniel M O'Connell
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Lisa M Arkin
- Department of Dermatology.,Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Schneider SL, Foster K, Patel D, Shwayder T. Cutaneous manifestations of metastatic Crohn's disease. Pediatr Dermatol 2018; 35:566-574. [PMID: 29952016 DOI: 10.1111/pde.13565] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Metastatic Crohn's disease is a rare cutaneous complication of primary Crohn's disease. It is a granulomatous inflammatory process, similar to the pathogenic mechanism of Crohn's disease, that occurs in sites discontiguous from the gastrointestinal tract. Metastatic Crohn's disease can precede the development of Crohn's disease by months to years, and children are more likely to present with metastatic Crohn's disease in the absence of gastrointestinal symptoms. Given that approximately 30% of individuals with Crohn's disease present in childhood, early recognition of extraintestinal manifestations of Crohn's disease such as metastatic Crohn's disease can aid in timely diagnosis and management of bowel disease. We present data from two pediatric cases of metastatic Crohn's disease recently seen at our institution in addition to the 61 reported cases of pediatric metastatic Crohn's disease in the literature. This review article will focus on the epidemiology, pathogenesis, clinical features, and histology of and treatment options for pediatric metastatic Crohn's disease.
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Affiliation(s)
| | | | - Devika Patel
- Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - Tor Shwayder
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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40
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Affiliation(s)
- Megan S Evans
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul B Googe
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dean S Morrell
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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41
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Saito K, Iwata Y, Nakajima Y, Numata S, Sugiura K. Metastatic Crohn's disease in childhood: A case report. J Dermatol 2018; 45:e199-e200. [PMID: 29341218 DOI: 10.1111/1346-8138.14215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kenta Saito
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yohei Iwata
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoko Nakajima
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shigeki Numata
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazumitsu Sugiura
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
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42
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Guglielmetti A, Gompertz M, Jahr C, Silva T, González S. Remission of refractory metastatic Crohn's disease achieved with dapsone. Int J Dermatol 2018; 57:467-469. [PMID: 29318573 DOI: 10.1111/ijd.13885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/29/2017] [Accepted: 11/29/2017] [Indexed: 12/01/2022]
Affiliation(s)
| | - Matías Gompertz
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina Jahr
- Department of Dermatology, University of Valparaíso, Valparaíso, Chile
| | - Tomas Silva
- Department of Dermatology, University of Valparaíso, Valparaíso, Chile
| | - Sergio González
- Department of Pathology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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A Boy With Genital Lesions in Course of Crohn Disease. J Pediatr Gastroenterol Nutr 2017; 65:e74-e75. [PMID: 28394847 DOI: 10.1097/mpg.0000000000001600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Abstract
BACKGROUND AND AIM Vulval Crohn's disease (VCD) is a rare extraintestinal cutaneous manifestation of Crohn's disease. No consensus on the diagnostic workup and therapeutic management of this condition has been provided in the current literature. PATIENTS AND METHODS Retrospective, multicentre descriptive case series of female patients diagnosed and treated with VCD. By chart review, data on initial symptoms, clinical courses, histologic findings and therapeutic management were collected. RESULTS Fifteen female patients with a median age of 28 years (interquartile range: 28-44 years) suffering from Crohn's disease of the ileum (27%), colon (33%) and ileocolon (40%) were included. VCD manifested most frequently with vulval swelling (93%), pain (80%) and erythema (73%). Histologic analysis demonstrated granulomatous inflammation in 78% and a mixed inflammatory cell infiltrate in 67% of cases. In eight (53%) cases, topical therapy resulted in temporary reduction of vulval symptoms. Combotreatment with immunosuppressive agents and tumour necrosis factor α inhibitors was the most effective second-line therapy: five (33%) patients achieved sustained clinical remission with this therapeutic strategy. CONCLUSION The diagnostic workup of VCD is challenging and should be approached in a multidisciplinary manner. Histopathologic analysis of the vulva supports the diagnosis. Topical therapy and systemic treatment with immunosuppressive agents and tumour necrosis factor α inhibitors are advised to treat this condition.
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Schlak A, Greenfield K, Crewe S, Lee CC. Abnormal Findings Lead to Surprising Diagnosis. Clin Pediatr (Phila) 2017; 56:402-404. [PMID: 27169715 DOI: 10.1177/0009922816649002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Amanda Schlak
- 1 Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | | | | | - Clifton C Lee
- 1 Children's Hospital of Richmond at VCU, Richmond, VA, USA
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Lymphœdème vulvaire chronique révélant une maladie de Crohn. Arch Pediatr 2017; 24:346-349. [DOI: 10.1016/j.arcped.2016.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/23/2016] [Accepted: 12/26/2016] [Indexed: 11/20/2022]
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Friedman BJ, Dasgeb B, Lee JB. Cutaneous Crohn's disease with superimposed psoriasis: A unique case with overlapping histology. J Cutan Pathol 2017; 44:588-590. [PMID: 28294378 DOI: 10.1111/cup.12928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 01/15/2023]
Abstract
Crohn's disease (CD) is an idiopathic, chronic inflammatory disorder of the gastrointestinal tract. We recently encountered a unique case in which a patient with longstanding CD presented with skin lesions with histopathologic features of both psoriasis and granulomatous inflammation suggestive of cutaneous CD. To our knowledge, this has not been described concomitantly in the same patient, in the same lesions. Review of the literature suggests that the intersection of these 2 histopathological reaction patterns may not be pure coincidence. Clinical-pathologic correlation of this case will be discussed, along with a review of the potential mechanisms of this unique disease presentation.
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Affiliation(s)
- Ben J Friedman
- Department of Dermatology & Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Bahar Dasgeb
- Department of Dermatology & Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason B Lee
- Department of Dermatology & Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
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49
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Metastatic Crohn Disease. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Granulomas of the skin may be classified in several ways. They are either infectious or non-infectious in character, and they contain areas of necrobiosis or necrosis, or not. Responsible infectious agents may be mycobacterial, fungal, treponemal, or parasitic organisms, and each case of granulomatous dermatitis should be assessed histochemically for those microbes. In the non-infectious group, examples of necrobiotic or necrotizing granulomas include granuloma annulare; necrobiosis lipoidica; rheumatoid nodule; and lupus miliaris disseminates faciei. Non-necrobiotic/necrotizing and non-infectious lesions are exemplified by sarcoidosis; foreign-body reactions; Melkersson-Rosenthal syndrome; Blau syndrome; elastolytic granuloma; lichenoid and granulomatous dermatitis; interstitial granulomatous dermatitis; cutaneous involvement by Crohn disease; granulomatous rosacea; and granulomatous pigmented purpura. Histiocytic dermatitides that do not feature granuloma formation are peculiar reactions to infection, such as cutaneous malakoplakia; leishmaniasis; histoplasmosis; lepromatous leprosy; rhinoscleroma; lymphogranuloma venereum; and granuloma inguinale.
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Affiliation(s)
- Mark R Wick
- Section of Dermatopathology, Division of Surgical & Cytological Pathology, University of Virginia Medical Center, Charlottesville, VA, USA.
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