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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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Cai ZP, Liu X, Liu W. Erythema induratum in a patient with recurrent oral ulceration: Crohn's disease of the esophagus and colon. Am J Med Sci 2023; 366:e105-e106. [PMID: 37482216 DOI: 10.1016/j.amjms.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/18/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Zi-Ping Cai
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China; Institute of Digestive Disease, China Three Gorges University, Yichang, China; Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
| | - Xu Liu
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China; Institute of Pathology, China Three Gorges University, Yichang, China; Department of Pathology, Yichang Central People's Hospital, Yichang, China
| | - Wei Liu
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China; Institute of Digestive Disease, China Three Gorges University, Yichang, China; Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China.
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Dhattarwal N, Ramesh V. Tuberculids: A Narrative Review. Indian Dermatol Online J 2023; 14:320-329. [PMID: 37266079 PMCID: PMC10231720 DOI: 10.4103/idoj.idoj_284_22] [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] [Received: 05/14/2022] [Revised: 07/10/2022] [Accepted: 07/16/2022] [Indexed: 06/03/2023] Open
Abstract
Tuberculids are a group of dermatoses with tuberculoid histology and the absence of tubercle bacilli. They are considered to be hypersensitivity reactions to circulating Mycobacterium tuberculosis (M. tb) or its antigens in individuals with good immunity. The objective of the review is to provide a detailed literature review of all available articles on tuberculids in the past 10 years and provide an update on epidemiology, etiopathogenetic mechanisms, clinical manifestations, and treatment. A search was performed on PubMed using the keywords lichen scrofulosorum, papulonecrotic tuberculid, erythema induratum, and erythema nodosum tuberculosis for all articles, with no restrictions on age, gender, or nationalities. An update on tuberculids, including some new concepts in pathogenesis, atypical presentations, new investigative modalities, and treatments are reviewed.
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Affiliation(s)
- Niharika Dhattarwal
- Department of Dermatology and STD, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - V. Ramesh
- Department of Dermatology, ESIC Medical College and Hospital, Faridabad, Haryana, India
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Borges AS, Brasileiro A, Apetato M. Nodular vasculitis associated with lung adenocarcinoma. An Bras Dermatol 2019; 93:887-889. [PMID: 30484537 PMCID: PMC6256222 DOI: 10.1590/abd1806-4841.20187741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/22/2018] [Indexed: 11/22/2022] Open
Abstract
Nodular vasculitis is an uncommon type of panniculitis. It was firstly associated to the infection by Mycobacterium tuberculosis and named erythema induratum of Bazin, however nowadays it has been associated with several other underlying disorders and it is better described as nodular vasculitis. Concerning its relationship with malignant conditions, there is only one reported case, in association with metastatic colon adenocarcinoma. We report a case of nodular vasculitis as the first manifestation of lung adenocarcinoma. To the best of our knowledge, this is the first reported association of both diseases.
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Affiliation(s)
- Ana Sofia Borges
- Department of Dermatology and Venereology, Hospital Santo
António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon,
Portugal
| | - Ana Brasileiro
- Department of Dermatology and Venereology, Hospital Santo
António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon,
Portugal
| | - Margarida Apetato
- Department of Dermatology and Venereology, Hospital Santo
António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon,
Portugal
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Abstract
Erythema induratum (EI), or nodular vasculitis (NV), is a type of panniculitis that is often associated with vasculitis affecting various-sized veins, venules, and arteries in reaction to various causative factors. Historically, EI was highly linked to tuberculosis, but in 1946, Montgomery first proposed the term NV to describe cases of EI not associated with tuberculosis. Only 2 reports of NV associated with inflammatory bowel disease have been reported in the literature. The authors report a 60-year-old woman with Crohn's disease presenting with exacerbation of NV in the setting of vedolizumab therapy.
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Pinato DJ, Newsom-Davis T. Regression of Paraneoplastic Rash after Lung Cancer Chemotherapy. J Thorac Oncol 2017; 13:139-140. [PMID: 29042270 DOI: 10.1016/j.jtho.2017.09.1967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 11/17/2022]
Affiliation(s)
- David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom.
| | - Thomas Newsom-Davis
- Department of Oncology, Chelsea and Westminster Hospital, London, United Kingdom
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Abstract
The diagnosis of panniculitis is felt to be a confusing topic by some pathologists. This summarical article presents inflammatory diseases of the subcutis in a systematic fashion, based on whether they are centered on fibrovascular septa or the adipose lobules, and whether morphologic vasculitis is present or not. Septocentric, non-vasculitis disorders include erythema nodosum, panniculitis that follows the use of "biological" therapeutic agents, lipodermatosclerosis, post-irradiation panniculitis, morphea profunda, and necrobiosis lipodica profunda. Polyarteritis nodosa and Behçet's disease are the conditions that are based in the subcutaneous septa with vasculitis. Predominantly-lobular panniculitides with no vasculitis include pancreatogenic panniculitis, the panniculitis of alpha-1-antitrypsin deficiency, panniculitis associated with lupus erythematosus and dermatomyositis, subcutaneous Sweet syndrome, eosinophilic panniculitis, factitial panniculitis, cold panniculitis, panniculitis following injections of corticosteroids, lipomembranous (ischemic) panniculitis; sclerema neonatorum and subcutaneous fat necrosis of the newborn, and Rosai-Dorfman disease of the subcutis. Erythema induratum and infectious panniculitis are vasculitic and lobulocentric conditions. This article reviews the histological features of these diseases.
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Affiliation(s)
- Mark R Wick
- Section of Dermatopathology,Dermatopathology, Division of Surgical Pathology & Cytopathology, University of Virginia Medical Center, Charlottesville, VA, USA.
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Ratzinger G, Zelger BG, Carlson JA, Burgdorf W, Zelger B. Das Vaskulitis-Rad - ein algorithmischer Ansatz für kutane Vaskulitiden. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.20_12859] [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)
- Gudrun Ratzinger
- Universitätsklinik für Dermatologie und Venerologie; Medizinische Universität Innsbruck; Innsbruck Österreich
| | | | - J. Andrew Carlson
- Department of Pathology; Divisions of Dermatology and Dermatopathology, Albany Medical College; Albany New York USA
| | - Walter Burgdorf
- Abteilung für Dermatologie und Allergologie; Ludwig-Maximilians-Universität München; München Deutschland
| | - Bernhard Zelger
- Universitätsklinik für Dermatologie und Venerologie; Medizinische Universität Innsbruck; Innsbruck Österreich
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