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Berner A, Coen M, Egervari K, Lobrinus JA, Grosjean A, Gressot P, Ribeiro Da Costa R, Farhoumand PD, Serratrice J. When Crouching Gait Reveals Crohn's Disease. Am J Med 2024; 137:414-416. [PMID: 38043886 DOI: 10.1016/j.amjmed.2023.11.009] [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: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Amandine Berner
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Switzerland.
| | - Matteo Coen
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Switzerland; Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Switzerland
| | - Kristof Egervari
- Division of Clinical Pathology, Diagnostic Department, Geneva University Hospitals, Switzerland
| | | | - Alicia Grosjean
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Switzerland
| | - Pablo Gressot
- Division of Gastroenterology and Hepatology, Department of Medicine, Geneva University Hospitals, Switzerland
| | - Rui Ribeiro Da Costa
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Switzerland
| | | | - Jacques Serratrice
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Switzerland
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2
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Hafner S, Seufferlein T, Kleger A, Müller M. Symptoms and Management of Aseptic Liver Abscesses. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:208-217. [PMID: 37827501 DOI: 10.1055/a-2075-5082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Aseptic liver abscesses occur very rarely. Clinical guidelines on the management of the disease do not exist, and the diagnosis is challenging.We screen MEDLINE and PUBMED databases for relevant case reports from inception to November 2022. Information on patient age, sex, initial symptoms, the extent of abscess formation, further diagnoses, treatment, and course of the disease is analyzed.Thirty cases with sterile hepatic abscess formation are identified. In most patients (n=18), the spleen is affected as well. Patients typically present with fever, abdominal pain, and increased inflammatory values. Comorbidity with inflammatory bowel disease is very common (n=18) and is associated with a significantly younger age at the time of hepatic abscess development. In addition, many patients show autoimmune-mediated cutaneous, ocular, or arthritic rheumatoid manifestations. Histological examination of abscess material reveals neutrophilic infiltration. The majority of patients initially receive corticosteroid therapy. Furthermore, response to azathioprine, anti-TNF-α antibodies, and other immunomodulatory drugs is reported. Ten out of fourteen patients with a long-term follow-up (≥ 36 months) have at least one relapse of hepatic abscess formation.Aseptic hepatic abscesses should be considered in the case of sterile punctures and non-response to antibiotics. Patients with aseptic liver abscesses have a high risk of recurrence warranting immunomodulatory maintenance therapy.
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Affiliation(s)
- Susanne Hafner
- Institute of Experimental and Clinical Pharmacology, Toxicology and Pharmacology of Natural Products, University Ulm Medical Centre, Ulm, Germany
| | | | - Alexander Kleger
- Internal Medicine I, University Ulm Medical Centre, Ulm, Germany
| | - Martin Müller
- Internal Medicine I, University Ulm Medical Centre, Ulm, Germany
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3
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Polyakova IN, Miroshnichenko AP, Aleksandrova MI, Stryuk RI. Aseptic nasal septal abscess in patients with ulcerative colitis: two case reports. Case report. TERAPEVT ARKH 2022; 94:884-890. [DOI: 10.26442/00403660.2022.07.201736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Indexed: 11/22/2022]
Abstract
Ulcerative colitis (UC) may be associated with different extra-intestinal manifestations (EIM), which are often difficult to diagnose and treat, and may complicate the course of the disease. EIM are a multidisciplinary problem encountered by doctors of various specializations. However, many incidences of EIM in patients with UC remain unknown. The coexistence of UC and aseptic nasal abscess (ANA) is uncommon. Here, we describe two cases of ANA in young female patients with UC. ANA run in parallel with intestinal disease activity and led to necrosis of the septal cartilage. Moreover, pyoderma gangrenosum was described in one of them. Aseptic abscess syndrome should be kept in mind when a microbial factor is not identified, the diagnosis is not clear or a patient is not improving on appropriate antibacterial therapy. ANA can present as a rare complication of UC.
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4
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Trefond L, Frances C, Costedoat-Chalumeau N, Piette JC, Haroche J, Sailler L, Assaad S, Viallard JF, Jego P, Hot A, Connault J, Galempoix JM, Aslangul E, Limal N, Bonnet F, Faguer S, Chosidow O, Deligny C, Lifermann F, Maria ATJ, Pereira B, Aumaitre O, André M. Aseptic Abscess Syndrome: Clinical Characteristics, Associated Diseases, and up to 30 Years’ Evolution Data on a 71-Patient Series. J Clin Med 2022; 11:jcm11133669. [PMID: 35806955 PMCID: PMC9267245 DOI: 10.3390/jcm11133669] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 12/05/2022] Open
Abstract
Aseptic abscess (AA) syndrome is a rare type of inflammatory disorder involving polymorphonuclear neutrophils (PMNs), often associated with inflammatory bowel disease (IBD). This study sought to describe the clinical characteristics and evolution of this syndrome in a large cohort. We included all patients included in the French AA syndrome register from 1999 to 2020. All patients fulfilled the criteria outlined by André et al. in 2007. Seventy-one patients were included, 37 of which were men (52.1%), of a mean age of 34.5 ± 17 years. The abscesses were located in the spleen (71.8%), lymph nodes (50.7%), skin (29.5%), liver (28.1%), lung (22.5), and rarer locations (brain, genitals, kidneys, ENT, muscles, or breasts). Of all the patients, 59% presented with an associated disease, primarily IBD (42%). They were treated with colchicine (28.1%), corticosteroids (85.9%), immunosuppressants (61.9%), and biologics (32.3%). A relapse was observed in 62% of cases, mostly in the same organ. Upon multivariate analysis, factors associated with the risk of relapse were: prescription of colchicine (HR 0.52; 95% CI [0.28–0.97]; p = 0.042), associated IBD (HR 0.57; 95% CI [0.32–0.99]; p = 0.047), and hepatic or skin abscesses at diagnosis (HR 2.14; 95% CI [1.35–3.40]; p = 0.001 and HR 1.78; 95% CI [1.07–2.93]; p = 0.024, respectively). No deaths occurred related to this disease. This large retrospective cohort study with long follow up showed that AA syndrome is a relapsing systemic disease that can evolve on its own or be the precursor of an underlying disease, such as IBD. Of all the available treatments, colchicine appeared to be protective against relapse.
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Affiliation(s)
- Ludovic Trefond
- Médecine Interne, CHU Gabriel Montpied, 63000 Clermont-Ferrand, France; (O.A.); (M.A.)
- M2iSH, UMR 1071 Inserm, INRA USC 2018, University of Clermont Auvergne, 63000 Clermont-Ferrand, France
- Correspondence:
| | - Camille Frances
- Faculté de Médecine, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, Sorbonne Université, 75252 Paris, France;
| | - Nathalie Costedoat-Chalumeau
- APHP, Service de Médecine Interne, Centre de Référence des Maladies Auto-Immunes Systémiques Rares d’Ile de France, Hôpital Cochin, 27 rue du Faubourg St-Jacques, CEDEX 14, 75679 Paris, France;
- INSERM U 1153, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, 75006 Paris, France
| | - Jean-Charles Piette
- Service de Médecine Interne, AP-HP Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France;
| | - Julien Haroche
- Assistance Publique–Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié–Salpêtrière (GHPS), French National Reference Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Sorbonne Université, 75252 Paris, France;
| | - Laurent Sailler
- Internal Medicine Department, CHU de Toulouse—Hôpital Purpan, 31300 Toulouse, France;
| | | | - Jean-François Viallard
- Hôpital Haut-Lévêque, CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Université de BORDEAUX, 5 Avenue de Magellan, 33604 Pessac, France;
| | - Patrick Jego
- Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Inserm, EHESP, University of Rennes, 35000 Rennes, France;
- Department of Internal Medicine, Rennes University Hospital, 35203 Rennes, France
| | - Arnaud Hot
- Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69437 Lyon, France;
| | - Jerome Connault
- Department of Internal and Vascular Medicine, CHU de Nantes, 44000 Nantes, France;
| | | | - Elisabeth Aslangul
- Service de Médecine Interne, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, 92701 Colombes, France;
- UPD5, Université Paris-Descartes, rue de l’École-de-Médecine, 75006 Paris, France
| | - Nicolas Limal
- Département de Médecine Interne, Hôpital Henri Mondor, APHP Université Paris-Est Créteil, 94010 Créteil, France;
| | - Fabrice Bonnet
- Department of Internal Medicine and Infectious Diseases, Bordeaux University Hospital, Saint André Hospital, 33000 Bordeaux, France;
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d’Organes, Centre de Référence des Maladies Rénales Rares, CHU de Toulouse, 31000 Toulouse, France;
| | - Olivier Chosidow
- Department of Dermatology, APHP, Hôpital Henri-Mondor, 94010 Créteil, France;
- Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d’Alfort, USC ANSES, Université Paris-Est Créteil, 94010 Créteil, France
| | - Christophe Deligny
- Service de Médecine Interne, CHU de Fort de France, 97200 Fort de France, France;
| | | | | | - Bruno Pereira
- Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Olivier Aumaitre
- Médecine Interne, CHU Gabriel Montpied, 63000 Clermont-Ferrand, France; (O.A.); (M.A.)
- M2iSH, UMR 1071 Inserm, INRA USC 2018, University of Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Marc André
- Médecine Interne, CHU Gabriel Montpied, 63000 Clermont-Ferrand, France; (O.A.); (M.A.)
- M2iSH, UMR 1071 Inserm, INRA USC 2018, University of Clermont Auvergne, 63000 Clermont-Ferrand, France
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5
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Nasri I, Ramdani Y, Lemaignen A, Ferreira-Maldent N, Bigot A, Boucaud A, Maillot F, Audemard-Verger A. [Multiple liver lesions]. Rev Med Interne 2021; 43:57-58. [PMID: 34922782 DOI: 10.1016/j.revmed.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/30/2021] [Indexed: 11/16/2022]
Affiliation(s)
- I Nasri
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France
| | - Y Ramdani
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France; Service de maladies infectieuses, CHRU Tours, Tours, France
| | - A Lemaignen
- Service de maladies infectieuses, CHRU Tours, Tours, France; Université de Tours, Tours, France
| | - N Ferreira-Maldent
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France
| | - A Bigot
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France
| | - A Boucaud
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France
| | - F Maillot
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France; Service de maladies infectieuses, CHRU Tours, Tours, France
| | - A Audemard-Verger
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France; Service de maladies infectieuses, CHRU Tours, Tours, France.
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Abstract
A 43-year-old woman with Crohn's disease was admitted to the hospital with weight loss and 1 week of fever, abdominal pain and diarrhoea. At presentation, the patient was not on steroids or other immunosuppressive agents. Cross-sectional imaging of the abdomen revealed active colitis and multiple splenic and hepatic abscesses. All culture data were negative, including aspiration of purulent material from the spleen. Despite weeks of intravenous antibiotics, daily fever and abdominal pain persisted, the intra-abdominal abscesses grew, and she developed pleuritic chest pain and consolidations of the right lung. The patient was ultimately diagnosed with aseptic abscess syndrome, a rare sequelae of inflammatory bowel disease. All antimicrobials were discontinued and she was treated with high-dose intravenous steroids, resulting in rapid clinical improvement. She was transitioned to infliximab and azathioprine as an outpatient and repeat imaging demonstrated complete resolution of the deep abscesses that had involved her spleen, liver and lungs.
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Affiliation(s)
- Hannah Fillman
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Patricio Riquelme
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Peter D Sullivan
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - André Martin Mansoor
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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7
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Hostalrich A, Porterie J, Ricco JB, De Almeida S, Chaufour X. Complete aortic replacement in aortitis due to aseptic abscess syndrome. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:216-220. [PMID: 32368703 PMCID: PMC7184059 DOI: 10.1016/j.jvscit.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/20/2020] [Indexed: 10/30/2022]
Abstract
A 36-year-old man was admitted for a tender inflammatory type IV thoracoabdominal aortic aneurysm with multiple aortic dilations. After open repair, he remained frail, but results of all infectious and inflammatory investigations were negative. Hypermetabolic intrasplenic collections were discovered on postoperative computed tomography, and aortitis with aseptic abscess syndrome was strongly suggested. Immunosuppressive therapy was undertaken, and his health improved dramatically. After 7 years of treatment, however, the initial aortic dilations had developed in size, necessitating multiple surgical procedures leading to complete aortic replacement. The postoperative course was uneventful with a satisfactory final computed tomography scan. Subsequent to immunotherapy, no new aneurysm developed.
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Affiliation(s)
- Aurélien Hostalrich
- Department of Vascular Surgery, Rangueil University Hospital, Toulouse, France
| | - Jean Porterie
- Department of Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France
| | - Jean Baptiste Ricco
- Department of Clinical Research, University Hospital of Poitiers, Poitiers, France
| | | | - Xavier Chaufour
- Department of Vascular Surgery, Rangueil University Hospital, Toulouse, France
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8
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Elessa D, Thietart S, Corpechot C, Fain O, Mekinian A. TNF-α antagonist infliximab for aseptic abscess syndrome. Presse Med 2019; 48:1579-1580. [PMID: 31757730 DOI: 10.1016/j.lpm.2019.09.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/19/2019] [Accepted: 09/30/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Dikelele Elessa
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de médecine interne et inflammation (DHUi2B), 75012 Paris, France
| | - Sara Thietart
- Assistance publique-hôpitaux de Paris, Saint-Antoine hospital, Sorbonne university, Saint-Antoine research center, reference center for inflammatory biliary diseases and autoimmune hepatitis, Inserm UMR_S938, 75012 Paris, France
| | - Christophe Corpechot
- Assistance publique-hôpitaux de Paris, Saint-Antoine hospital, Sorbonne university, Saint-Antoine research center, reference center for inflammatory biliary diseases and autoimmune hepatitis, Inserm UMR_S938, 75012 Paris, France
| | - Olivier Fain
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de médecine interne et inflammation (DHUi2B), 75012 Paris, France
| | - Arsene Mekinian
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service de médecine interne et inflammation (DHUi2B), 75012 Paris, France.
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9
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Georgin-Lavialle S, Fayand A, Rodrigues F, Bachmeyer C, Savey L, Grateau G. Autoinflammatory diseases: State of the art. Presse Med 2019; 48:e25-e48. [PMID: 30686513 DOI: 10.1016/j.lpm.2018.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Autoinflammatory diseases are characterized by innate immunity abnormalities. In autoinflammatory diseases (AID), inflammatory blood biomarkers are elevated during crisis without infection and usually without autoantibodies. The first 4 described AID were familial Mediterranean fever, cryopyrin-associated periodic fever syndrome (CAPS) or NLRP3-associated autoinflammatory disease (NRLP3-AID), mevalonate kinase deficiency (MKD) and TNFRSF1A-receptor associated periodic fever syndrome (TRAPS). Since their description 20 years ago, and with the progresses of genetic analysis, many new diseases have been discovered; some with recurrent fever, others with predominant cutaneous symptoms or even immune deficiency. After describing the 4 historical recurrent fevers, some polygenic inflammatory diseases will also be shortly described such as Still disease and periodic fever with adenitis, pharyngitis and aphtous (PFAPA) syndrome. To better explore AID, some key anamnesis features are crucial such as the family tree, the age at onset, crisis length and organs involved in the clinical symptoms. An acute phase response is mandatory in crisis.
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Affiliation(s)
- Sophie Georgin-Lavialle
- AP-HP, hôpital Tenon, Sorbonne université, service de médecine interne, centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA), 75020 Paris, France; Assistance publique-Hôpitaux de Paris, hôpital Trousseau, université Pierre-et-Marie-Curie (UPMC)-Paris 6, Inserm UMRS_933, 75012 Paris, France.
| | - Antoine Fayand
- AP-HP, hôpital Tenon, Sorbonne université, service de médecine interne, centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA), 75020 Paris, France
| | - François Rodrigues
- AP-HP, hôpital Tenon, Sorbonne université, service de médecine interne, centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA), 75020 Paris, France
| | - Claude Bachmeyer
- AP-HP, hôpital Tenon, Sorbonne université, service de médecine interne, centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA), 75020 Paris, France
| | - Léa Savey
- AP-HP, hôpital Tenon, Sorbonne université, service de médecine interne, centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA), 75020 Paris, France
| | - Gilles Grateau
- AP-HP, hôpital Tenon, Sorbonne université, service de médecine interne, centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA), 75020 Paris, France; Assistance publique-Hôpitaux de Paris, hôpital Trousseau, université Pierre-et-Marie-Curie (UPMC)-Paris 6, Inserm UMRS_933, 75012 Paris, France
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10
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Doll R, Friedman K, Hostoffer R. Aseptic Abscess Syndrome, a Case of Prolonged Remission Following Splenectomy. Am J Gastroenterol 2018; 113:1264-1265. [PMID: 29904157 DOI: 10.1038/s41395-018-0163-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/22/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Rayna Doll
- University Hospitals, Cleveland Medical Center, Cleveland, OH, USA. University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Allergy and Immunology Associates, Mayfield Heights, OH, USA
| | - Kenneth Friedman
- University Hospitals, Cleveland Medical Center, Cleveland, OH, USA. University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Allergy and Immunology Associates, Mayfield Heights, OH, USA
| | - Robert Hostoffer
- University Hospitals, Cleveland Medical Center, Cleveland, OH, USA. University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Allergy and Immunology Associates, Mayfield Heights, OH, USA
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11
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Georgin-Lavialle S, Rodrigues F, Hentgen V, Fayand A, Quartier P, Bader-Meunier B, Bachmeyer C, Savey L, Louvrier C, Sarrabay G, Melki I, Belot A, Koné-Paut I, Grateau G. [Clinical overview of auto-inflammatory diseases]. Rev Med Interne 2018; 39:214-232. [PMID: 29501512 DOI: 10.1016/j.revmed.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/28/2017] [Accepted: 01/28/2018] [Indexed: 12/12/2022]
Abstract
Monogenic auto-inflammatory diseases are characterized by genetic abnormalities coding for proteins involved in innate immunity. They were initially described in mirror with auto-immune diseases because of the absence of circulating autoantibodies. Their main feature is the presence of peripheral blood inflammation in crisis without infection. The best-known auto-inflammatory diseases are mediated by interleukines that consisted in the 4 following diseases familial Mediterranean fever, cryopyrinopathies, TNFRSF1A-related intermittent fever, and mevalonate kinase deficiency. Since 10 years, many other diseases have been discovered, especially thanks to the progress in genetics. In this review, we propose the actual panorama of the main known auto-inflammatory diseases. Some of them are recurrent fevers with crisis and remission; some others evaluate more chronically; some are associated with immunodeficiency. From a physiopathological point of view, we can separate diseases mediated by interleukine-1 and diseases mediated by interferon. Then some polygenic inflammatory diseases will be shortly described: Still disease, Schnitzler syndrome, aseptic abscesses syndrome. The diagnosis of auto-inflammatory disease is largely based on anamnesis, the presence of peripheral inflammation during attacks and genetic analysis, which are more and more performant.
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Affiliation(s)
- S Georgin-Lavialle
- Service de médecine interne, université Paris 6, Pierre-et-Marie-Curie (UPMC), hôpital Tenon, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, université Pierre-et-Marie-Curie (UPMC)-Paris 6, hôpital Trousseau, Assistance publique-Hôpitaux de Paris, 75012 Paris, France; Centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), 75020 Paris, France.
| | - F Rodrigues
- Service de médecine interne, université Paris 6, Pierre-et-Marie-Curie (UPMC), hôpital Tenon, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue de la Chine, 75020 Paris, France
| | - V Hentgen
- Centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), 75020 Paris, France; Service de pédiatrie générale, centre hospitalier de Versailles, 179, rue de Versailles, 78150 Le Chesnay, France
| | - A Fayand
- Service de médecine interne, université Paris 6, Pierre-et-Marie-Curie (UPMC), hôpital Tenon, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue de la Chine, 75020 Paris, France
| | - P Quartier
- Unité d'immunologie-hématologie et rhumatologie pédiatriques et institut IMAGINE, université Paris-Descartes, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France; Centre de référence national maladies rares pour les rhumatismes inflammatoires et les maladies auto-immunes systémiques de l'enfant (RAISE), 75015 Paris, France
| | - B Bader-Meunier
- Unité d'immunologie-hématologie et rhumatologie pédiatriques et institut IMAGINE, université Paris-Descartes, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France; Centre de référence national maladies rares pour les rhumatismes inflammatoires et les maladies auto-immunes systémiques de l'enfant (RAISE), 75015 Paris, France
| | - C Bachmeyer
- Service de médecine interne, université Paris 6, Pierre-et-Marie-Curie (UPMC), hôpital Tenon, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue de la Chine, 75020 Paris, France; Centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), 75020 Paris, France
| | - L Savey
- Service de médecine interne, université Paris 6, Pierre-et-Marie-Curie (UPMC), hôpital Tenon, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue de la Chine, 75020 Paris, France; Centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), 75020 Paris, France
| | - C Louvrier
- Inserm UMRS_933, université Pierre-et-Marie-Curie (UPMC)-Paris 6, hôpital Trousseau, Assistance publique-Hôpitaux de Paris, 75012 Paris, France
| | - G Sarrabay
- Centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), 75020 Paris, France; Laboratoire de génétique, CHU de Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - I Melki
- Unité d'immunologie-hématologie et rhumatologie pédiatriques et institut IMAGINE, université Paris-Descartes, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France; Centre de référence national maladies rares pour les rhumatismes inflammatoires et les maladies auto-immunes systémiques de l'enfant (RAISE), 75015 Paris, France; Service de pédiatrie générale, maladies infectieuses et médecine interne pédiatrique, centre hospitalier Robert-Debré, 75020 Paris, France
| | - A Belot
- Centre de référence national maladies rares pour les rhumatismes inflammatoires et les maladies auto-immunes systémiques de l'enfant (RAISE), 75015 Paris, France; Inserm U1111, service de néphrologie, rhumatologie, dermatologie pédiatriques, université Lyon 1, hôpital Femme-Mère-Enfant, 69677 Bron, France
| | - I Koné-Paut
- Centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), 75020 Paris, France; Service de rhumatologie pédiatrique, université de Paris-Sud, CHU de Bicêtre, Assistance publique-Hôpitaux de Paris, 94270 Paris, France
| | - G Grateau
- Service de médecine interne, université Paris 6, Pierre-et-Marie-Curie (UPMC), hôpital Tenon, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, université Pierre-et-Marie-Curie (UPMC)-Paris 6, hôpital Trousseau, Assistance publique-Hôpitaux de Paris, 75012 Paris, France; Centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), 75020 Paris, France
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12
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Herskovitz I, Maderal AD, Alonso-Llamazares J. Caseating granulomas manifesting as aseptic abscesses in the setting of ulcerative colitis. Int J Dermatol 2018; 57:475-476. [PMID: 29417548 DOI: 10.1111/ijd.13886] [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: 04/25/2017] [Revised: 09/22/2017] [Accepted: 11/29/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Ingrid Herskovitz
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea D Maderal
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Javier Alonso-Llamazares
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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13
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Yildiz H, Munting A, Komuta M, Danse E, Lefebvre C. Aseptic lung and liver abscesses: a diagnostic challenge. Acta Clin Belg 2017; 72:259-263. [PMID: 27498958 DOI: 10.1080/17843286.2016.1215888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 67-year-old man known with systemic sarcoidosis was admitted to the department of internal medicine because of cough and chest pain for several weeks. Thoracic tomodensitometry demonstrated multiple pulmonary nodules. Biopsies revealed features compatible with abscesses. Cultures and serologic tests were negative and the patient was successfully treated with prednisone. Three years later, a thoraco-abdominal tomodensitometry showed a relapse in the lung and also the apparition of similar lesions in the liver. Blood test revealed elevated CRP level at 40 mg/L and mild cholestasis. Biopsies of the liver excluded neoplastic or infectious diseases and showed inflammatory granulation tissue with abscess formation. A diagnosis of sarcoidosis-associated aseptic abscesses syndrome was then made, which was successfully treated with corticosteroids.
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Affiliation(s)
- Halil Yildiz
- Department of Internal Medicine, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Aline Munting
- Department of Internal Medicine, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mina Komuta
- Department of pathology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Etienne Danse
- Department of Radiology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Chantal Lefebvre
- Department of Internal Medicine, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
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14
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Sallé de Chou C, Ortonne N, Hivelin M, Wolkenstein P, Chosidow O, Valeyrie-Allanore L. [Aseptic cutaneous breast abscesses associated with ulcerative colitis]. Ann Dermatol Venereol 2016; 143:139-43. [PMID: 26852214 DOI: 10.1016/j.annder.2015.10.579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/10/2015] [Accepted: 10/02/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inflammatory bowel diseases are associated with a broad range of cutaneous lesions. Herein we report the first case of aseptic skin abscesses associated with ulcerative colitis. CASE REPORT Since March 2008, a 40-year-old woman presented with bilateral mammary abscesses, relapsing despite repeated antibiotic treatment. She was followed for ulcerative colitis diagnosed in 2011 by means of a rectal biopsy. Despite four surgical procedures, there was no improvement in her mammary abscesses and bilateral mastectomy was then proposed because of the persistent symptoms. Her general state of health remained stable. Clinically, there were bilateral inflammatory nodes with fistulae and pus. These lesions were extremely painful. Mild inflammatory syndrome was noted, but the immunological tests revealed nothing of note. Bacteriological, parasitological and mycological tests on biopsy specimens were negative. Histological examination of a surgical biopsy revealed lymphoplasmacytic infiltration of the dermis and subcutis with altered polymorphonuclear cells and epithelioid granuloma. The CT-scan showed no other remote lesions. The final diagnosis was cutaneous aseptic abscess syndrome associated with ulcerative colitis. Colchicine 1mg/day was initiated and resulted in regression of the skin lesions, with complete remission at one year of follow-up. DISCUSSION Aseptic abscess syndrome must be considered in the event of recurrent aseptic cutaneous abscesses which may be associated with inflammatory bowel disease. Surgery should be avoided and treatment should be based on suitable drug therapy.
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Affiliation(s)
- C Sallé de Chou
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - N Ortonne
- Université Paris Est Créteil (UPEC), faculté de médecine, 8, rue du Général-Sarrail, 94000 Créteil, France
| | - M Hivelin
- Inserm, centre d'investigation clinique 006, 94010 Créteil cedex, France
| | - P Wolkenstein
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - O Chosidow
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; Université Paris Est Créteil (UPEC), faculté de médecine, 8, rue du Général-Sarrail, 94000 Créteil, France; Inserm, centre d'investigation clinique 006, 94010 Créteil cedex, France
| | - L Valeyrie-Allanore
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
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Periodic Fever and Neutrophilic Dermatosis: Is It Sweet's Syndrome? Case Reports Immunol 2014; 2014:320920. [PMID: 25544911 PMCID: PMC4273503 DOI: 10.1155/2014/320920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/15/2014] [Indexed: 01/11/2023] Open
Abstract
A 7-year-old boy with high grade fever (39°C) and warm, erythematous, and indurated plaque above the left knee was referred. According to the previous records of this patient, these indurated plaques had been changed toward abscesses formation and then spontaneous drainage had occurred after about 6 to 7 days, and finally these lesions healed with scars. In multiple previous admissions, high grade fever, leukocytosis, and a noticeable increase in erythrocyte sedimentation rate and C-reactive protein were noted. After that, until 7th year of age, he had shoulder, gluteal, splenic, kidney, and left thigh lesions and pneumonia. The methylprednisolone pulse (30 mg/kg) was initiated with the diagnosis of Sweet's syndrome. After about 10-14 days, almost all of the laboratory data regressed to nearly normal limits. After about 5 months, he was admitted again with tachypnea and high grade fever and leukocytosis. After infusion of one methylprednisolone pulse, the fever and tachypnea resolved rapidly in about 24 hours. In this admission, colchicine (1 mg/kg) was added to the oral prednisolone after discharge. In the periodic fever and neutrophilic dermatosis, the rheumatologist should search for sterile abscesses in other organs.
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Jordan AJ, Becker KP, Sertemir M, Neff KW, Adam R, Schroten H, Tenenbaum T. Multiple aseptic splenic abscesses in a 15 year old patient. BMC Gastroenterol 2014; 14:20. [PMID: 24502393 PMCID: PMC3922344 DOI: 10.1186/1471-230x-14-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 02/03/2014] [Indexed: 11/25/2022] Open
Abstract
Background Splenic abscesses in children are rare. In recent years aseptic abscesses have been recognized as a new disease entity, especially in adults. Case presentation We present a rare case of a 15 year old girl with aseptic abscesses, in whom antibiotic therapy comprising metronidazole and meropenem was partly beneficial in improving the patient’s clinical condition and inflammatory parameters. Eventually corticosteroid therapy led to complete and long lasting resolution of symptoms. Further diagnostic work-up revealed autoimmune thyroiditis, but no signs of inflammatory bowel disease. Conclusion Aseptic splenic abscesses should always prompt clinicians to initiate further diagnostics to determine a potential underlying condition and a regular follow-up. Anaerobic bacteria may play a role in the pathogenesis of the disease and besides corticosteroid treatment antibiotics covering anaerobes may be beneficial.
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Affiliation(s)
| | | | | | | | | | | | - Tobias Tenenbaum
- Paediatric Infectious Diseases, Department of Paediatrics, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Cutaneous manifestations in patients with inflammatory bowel diseases: pathophysiology, clinical features, and therapy. Inflamm Bowel Dis 2014; 20:213-27. [PMID: 24105394 DOI: 10.1097/01.mib.0000436959.62286.f9] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The skin is one of the most common extraintestinal organ system affected in patients with inflammatory bowel disease (IBD), including both Crohn's disease and ulcerative colitis. The skin manifestations associated with IBD are polymorphic and can be classified into 4 categories according to their pathophysiology: (1) specific, (2) reactive, (3) associated, and (4) induced by IBD treatment. Cutaneous manifestations are regarded as specific if they share with IBD the same granulomatous histopathological pattern: perianal or metastatic Crohn's disease (commonly presenting with abscesses, fistulas or hidradenitis suppurativa-like features) is the prototype of this setting. Reactive cutaneous manifestations are different from IBD in the histopathology but have close physiopathological links: pyoderma gangrenosum, a neutrophil-mediated autoinflammatory skin disease typically manifesting as painful ulcers, is the paradigm of this group. Among the cutaneous diseases associated with IBD, the most commonly seen are erythema nodosum, a form of panniculitis most commonly involving bilateral pretibial areas, and psoriasis, a T helper 1/T helper 17-mediated erythematous squamous inflammatory disease. Finally, the number of cutaneous adverse reactions because of IBD therapies is progressively increasing. The most frequent drug-induced cutaneous manifestations are psoriasis-like, eczema-like, and lichenoid eruptions, as well as cutaneous lupus erythematosus for biologics, and nonmelanoma skin cancer, mainly basal cell and squamous cell carcinomas for thiopurines.
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Chelly I, Zehani A, Mbazaa A, Azouz H, Nfoussi H, Kchir N, Haouet S, Zitouna M. [Sweet's syndrome: retrospective case series of 47 patients]. Rev Med Interne 2012. [PMID: 23195911 DOI: 10.1016/j.revmed.2012.10.373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Also called acute febrile neutrophilic dermatosis, Sweet's syndrome is an inflammatory disorder with a prominent cutaneous expression. It is characterized by a variety of manifestations, clinical and histological findings. The objective of this study was to describe their clinical, pathological and therapeutic characteristics. METHODS We report on a series of 47 patients who presented a Sweet's syndrome, collected in our institution in Tunis between 1997 and 2011. RESULTS The patient population consisted of 11 men and 36 women. The mean age was 47 years with extreme ranging from 28 to 74 years. An associated disorder was observed in ten patients: inflammatory disease (three cases), inflammatory bowel disease (two cases), tuberculosis (three cases) and diabetes (three cases). One case of pregnancy was observed. Cutaneous lesions consisted of erythematous plaques or nodules. Lesions were located mainly on the upper or lower extremities. All biopsy specimens demonstrated a dermal infiltrate composed predominantly of neutrophils. Fibrinoid necrosis and intramural inflammation were observed in eight cases. CONCLUSION The skin disorder can precede, follow, or appear concurrent with the diagnosis of an associated disease which requires careful surveillance.
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Affiliation(s)
- I Chelly
- Service d'anatomie et de cytologie pathologiques, hôpital La Rabta, Tunis, Tunisie
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Audemard A, Verger H, Gendrot A, Jeanjean C, Auzary C, Geffray L. Association pyoderma gangrenosum, pustulose sous-cornée et abcès aseptiques spléniques : « une maladie neutrophilique ». Rev Med Interne 2012; 33:e28-30. [DOI: 10.1016/j.revmed.2011.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/16/2010] [Accepted: 04/16/2011] [Indexed: 12/24/2022]
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