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Kim CG, Kim YJ, Lee S, Kim TH, Kim H. Aseptic abscess associated with SAPHO syndrome: a case report. Skeletal Radiol 2023:10.1007/s00256-023-04493-3. [PMID: 37889316 DOI: 10.1007/s00256-023-04493-3] [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: 07/29/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
Aseptic abscess (AA) is a rare autoinflammatory disorder, characterized by the formation of sterile abscesses in various organs, and is accompanied by inflammatory bowel disease. Antibiotic treatment is ineffective, but steroid therapy shows a good response. AA can be difficult to differentiate from infection because abscesses appear similar both radiologically and histopathologically. Herein, we present the case of a 56-year-old woman with AA in the anterior chest wall and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome.
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Affiliation(s)
- Chang Guk Kim
- Department of Radiology, School of Medicine, Hanyang University Hospital, 222-1, Wangsimni-Ro Seongdong-Gu, Seoul, 04763, South Korea
| | - Yeo Ju Kim
- Department of Radiology, School of Medicine, Hanyang University Hospital, 222-1, Wangsimni-Ro Seongdong-Gu, Seoul, 04763, South Korea.
| | - Seunghun Lee
- Department of Radiology, School of Medicine, Hanyang University Hospital, 222-1, Wangsimni-Ro Seongdong-Gu, Seoul, 04763, South Korea
| | - Tae-Hwan Kim
- Division of Rheumatology, School of Medicine, Hanyang University Hospital, Seoul, 04763, South Korea
| | - Hyunsung Kim
- Department of Pathology, School of Medicine, Hanyang University Hospital, Seoul, 04763, South Korea
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Toba T, Ikegami R, Nogami A, Watanabe N, Fujii K, Ogawa Y, Hojo A, Fujimoto A, Matsuda T. Multiple ulcerative colitis-associated aseptic abscesses successfully treated with infliximab: a case report. Clin J Gastroenterol 2023:10.1007/s12328-023-01807-9. [PMID: 37097421 DOI: 10.1007/s12328-023-01807-9] [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: 02/22/2023] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Abstract
Aseptic abscesses are rare extraintestinal manifestations of inflammatory bowel disease. Herein, we present the case of a 69-year-old female patient with ulcerative colitis in whom multiple aseptic abscesses were successfully treated with infliximab. Aseptic abscesses associated with ulcerative colitis are difficult to differentiate from infectious abscesses. In the present case, we reached a diagnosis of aseptic abscesses associated with ulcerative colitis as antibiotics were ineffective and repeated Gram stains and cultures of blood and abscess were negative. Aseptic abscesses are commonly found in the spleen, lymph nodes, liver, and skin; however, in the present case, the periosteum was the major site. Prednisolone is often effective for aseptic abscesses; however, the present patient was initially treated with a combination of 40 mg/day of prednisolone and granulocyte and monocyte adsorption apheresis, with inadequate effect. Infliximab was administered as the patient was steroid-resistant, with strong effect. Subsequently, infliximab treatment has been continued, with no recurrence after 2 years. However, as there have been reports of cases of recurrence even after remission with treatment, careful follow-up in the future is therefore necessary.
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Affiliation(s)
- Takahito Toba
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan.
| | - Ryo Ikegami
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Akira Nogami
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Naoko Watanabe
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Kodai Fujii
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Yurie Ogawa
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Aya Hojo
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Ai Fujimoto
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
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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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Aseptic Abscesses and Inflammatory Bowel Disease: Two Cases and Review of Literature. Can J Gastroenterol Hepatol 2017; 2017:5124354. [PMID: 28265555 PMCID: PMC5317120 DOI: 10.1155/2017/5124354] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/22/2016] [Accepted: 01/22/2017] [Indexed: 12/14/2022] Open
Abstract
Background. Aseptic abscesses (AA) are sterile lesions that represent an extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD). Though Canada has the highest prevalence of IBD in the world, reports of IBD-associated AA are absent in Canada. This may represent a different IBD phenotype or underrecognition and underreporting. Purpose. To explore AA as a possible EIM of IBD and evaluate clinical and investigative findings among patients with IBD-associated AA. Methods. Retrospective chart and literature reviews were performed to find cases of IBD-associated AA at our institution and in the literature. Results. We identified 2 cases of IBD-associated AA in our institution. Both patients had ulcerative colitis and presented with fever, abdominal pain, and weight loss. Radiological workup and aspiration showed sterile splenic abscesses. The AA were unresponsive to antibiotics. One patient improved on corticosteroids and one underwent splenectomy. We retrieved 37 cases of IBD-associated AA from the literature. All patients showed no evidence of infection, failed to resolve with antibiotics, and, if attempted, improved on corticosteroids. Conclusions. Our cases are the first reported in Canada. They support literature which suggests AA as an EIM of IBD and may help increase recognition and reporting of this phenomenon.
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André MFJ, Piette JC, Kémény JL, Ninet J, Jego P, Delèvaux I, Wechsler B, Weiller PJ, Francès C, Blétry O, Wismans PJ, Rousset H, Colombel JF, Aumaître O. Aseptic abscesses: a study of 30 patients with or without inflammatory bowel disease and review of the literature. Medicine (Baltimore) 2007; 86:145-161. [PMID: 17505254 DOI: 10.1097/md.0b013e18064f9f3] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aseptic abscesses (AA) are characterized by deep, sterile, round lesions consisting of neutrophil that do not respond to antibiotics but improve dramatically with corticosteroids. We report the clinical, laboratory, and radiologic characteristics and the associated conditions of 29 patients from the French Register on AA plus 1 patient from the Netherlands.The mean age of patients at AA diagnosis was 29 years (SD = 14). The main clinical manifestations of AA were fever (90%), abdominal pain (67%), and weight loss (50%). Duration of symptoms was 4.7 months on average until abscesses were discovered. The abscesses involved the spleen in 27/29 patients (93%; the thirtieth patient had a personal history of splenectomy after a trauma). In 7 they were unifocal and in the others they were multifocal, involving in addition the abdominal lymph nodes in 14 (48%), liver in 12 (40%), lung in 5 (17%), pancreas in 2 (7%), and brain in 2 (7%). They were not splenic in 3, including 2 with abdominal lymph nodes and 1 with superficial lymph nodes and testicle and lung involvement. Twenty-two patients (70%) had elevated white blood cell and neutrophil count; antineutrophil cytoplasmic autoantibodies with a perinuclear, cytoplasmic or atypical pattern (negative for antiproteinase 3 and negative for antimyeloperoxidase except for 1) were positive in 21% of the 24 patients tested. Twenty-one patients had inflammatory bowel disease (IBD), which preceded the occurrence of abscesses in 7, was concomitant in 7, and appeared secondarily in 7. Six patients had neutrophilic dermatosis (20%), 3 had relapsing polychondritis as an associated condition, and 3 others had monoclonal gammopathy of undetermined significance. Three patients had no associated condition. Splenectomy was performed in 15 (52%) patients. All patients received steroid therapy. Thirteen (43%) were given additional immunosuppressive therapy, 1 immediately and the others after a relapse, of whom 3 were also treated by anti-tumor necrosis factor-alpha agents. Mean follow-up was 7 years. Eighteen (60%) patients experienced 1 or several relapses, but there was no death related to AA. Relapses occurred on immunosuppressive therapy in 2 patients and off immunosuppressive therapy in the others while corticosteroids were being tapered. We surveyed the literature and analyzed 19 additional cases. AA is an emergent and probably underrecognized entity. It represents an apparently noninfectious inflammatory disorder involving neutrophils that responds to corticosteroid therapy. AA mainly affects patients with IBD but also affects those with other conditions, or with no other apparent disease.
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Affiliation(s)
- Marc F J André
- From Service de Médecine Interne (MFJA, ID, OA) and Service d'Anatomie et Cytologie Pathologiques (JLK), CHU Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand; Inserm (MFJA), U384, Clermont-Ferrand; Service de Médecine Interne (JCP, BW), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris; Service de Médecine Interne (JN), Hôpitaux de Lyon, Hôpital Edouard-Herriot, Lyon; Service de Médecine Interne (PJ), CHU de Rennes, Hôpital Sud, Rennes; Service de Médecine Interne (PJW), CHU de Marseilles, Hôpital de la Timone, Marseilles; Service de Dermatologie (CF), Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris; Service de Médecine Interne (OB), Hôpital Foch, Suresnes; Service de Médecine Interne (HR), Hôpitaux de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite; Service d'Hépato-gastro-entérologie (JFC), CHU de Lille, Hopital Claude Huriez, Lille; Inserm (JFC), EPI 01-14, Lille, France; and Afd. Interne Geneeskunde (PJW), Havenziekenhuis & Instituut voor Tropische Ziekten, Rotterdam, The Netherlands
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Li KJ, Yu CL, Lin WC, Lu MC, Wu CH, Hsieh SC. Concomitant aseptic subcutaneous abscess and immunoglobulin m nephropathy--rare extraintestinal manifestations in ulcerative colitis. Dig Dis Sci 2006; 51:401-5. [PMID: 16534688 DOI: 10.1007/s10620-006-3144-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Accepted: 06/13/2005] [Indexed: 01/17/2023]
Affiliation(s)
- Ko Jen Li
- Division of Immunology, Rheumatology and Allergy, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Kocaoglu M, Somuncu I, Ors F, Bulakbasi N, Tayfun C, Ilkbahar S. Imaging Findings in Idiopathic Granulomatous Mastitis. J Comput Assist Tomogr 2004; 28:635-41. [PMID: 15480037 DOI: 10.1097/01.rct.0000131927.82761.40] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe magnetic resonance (MR) imaging features of patients with a histologic diagnosis of idiopathic granulomatous mastitis (IGM). METHODS Dynamic contrast-enhanced MR imaging was performed with a 1.5-T MR unit. Postprocessing of images included subtraction and calculation of time-intensity curves of the enhancing regions at several points in all patients. RESULTS In addition to granulomatous inflammation, biopsy slides of 5 patients demonstrated abscess formation without a specific organism (aseptic abscess). One patient had a fibrotic tissue component. Magnetic resonance imaging findings were heterogeneously enhancing areas with (n = 5) and without (n = 1) multiple ring-like enhanced abscesses and a circumscribed lesion with heterogeneous contrast enhancement (n = 1). Time-intensity curves showed a benign pattern in all but 1 patient. CONCLUSION Idiopathic granulomatous mastitis has a number of appearances on MR imaging. Magnetic resonance imaging with measurement of time-signal intensity curves may support the findings of ultrasonography and mammography in distinguishing benign inflammatory breast disorders from malignant ones; however, biopsy still remains the only method of definite diagnosis.
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Affiliation(s)
- Murat Kocaoglu
- Department of Radiology, Gülhane Military Medical School, 06018, Etlik, Ankara, Turkey.
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