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Sattler SS, Magro CM, Shapiro L, Merves JF, Levy R, Veenstra J, Patel P. Gastrointestinal Kohlmeier-Degos disease: a narrative review. Orphanet J Rare Dis 2022; 17:172. [PMID: 35443671 PMCID: PMC9022239 DOI: 10.1186/s13023-022-02322-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 04/09/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Kohlmeier-Degos (K-D) disease is a rare obliterative vasculopathy that can present as a benign cutaneous form or with potentially malignant systemic involvement. The gastrointestinal tract is most frequently involved in systemic disease and mortality is often related to bowel perforations. Herein, we provide information to providers and patients regarding gastrointestinal K-D symptomology, pathology, treatment, and diagnosis, with a focus on the importance of timely diagnostic laparoscopy. We present three new cases of gastrointestinal K-D to highlight varying disease presentations and outcomes. Body Based on reviewed reports, perforation is preceded by at least one gastrointestinal symptom: abdominal pain/cramping, anorexia/weight loss, vomiting, diarrhea, nausea, gastrointestinal bleeding, obstipation, constipation, and abdominal fullness. Perforation most commonly occurs in the small intestine and often results in sepsis and death. Although underutilized, laparoscopy is the most sensitive and specific diagnostic technique, demonstrating serosal porcelain plaques similar to those on the skin and characteristic for K–D. The combination of eculizumab and treprostinil is presently the most effective treatment option for gastrointestinal K–D. The pathology of gastrointestinal K-D is characterized by an obliterative intimal arteriopathy eventuating in occlusive acellular deposits of mucin and collagen along with an extravascular pauci-cellular sclerosing process resembling scleroderma confined to the subserosal fat. C5b-9 and interferon-alpha are both expressed in all caliber of vessels in the affected intestine. While C5b-9 blockade does not prevent the intimal expansion, enhanced type I interferon signaling is likely a key determinant to intimal expansion by, causing an influx of monocytes which transdifferentiate into procollagen-producing myofibroblast-like cells. Conclusion Prompt laparoscopic evaluation is necessary in any K–D patient with an abdominal symptom to facilitate diagnosis and treatment initiation, as well as to hopefully decrease mortality. Those with gastrointestinal K–D should start on eculizumab as soon as possible, as onset of action is immediate. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02322-9.
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Affiliation(s)
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lee Shapiro
- Division of Rheumatology, Albany Medical College, 6 Medical Park Drive, Malta, NY, 12020, USA.
| | - Jamie F Merves
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca Levy
- Division of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jesse Veenstra
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Puraj Patel
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
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Kim PJ, Lytvyn Y, Kashetsky N, Bagit A, Mufti A, Yeung J. Clinical manifestations and treatment outcomes in degos disease: a systematic review. J Eur Acad Dermatol Venereol 2021; 35:1655-1669. [PMID: 33914972 DOI: 10.1111/jdv.17311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
Degos disease (atrophic papulosis) is a rare vasculopathy with cutaneous and systemic manifestations. Although potentially fatal, the characteristics of and treatments for Degos disease variants are not adequately described. We conducted a systematic review to summarize cutaneous and systemic presentations, treatments and outcomes of malignant (MAP) and benign (BAP) variants of Degos disease. A comprehensive search was conducted on Embase, MEDLINE, CINAHL and CENTRAL on 27 October 2020, which yielded 254 original studies reporting cases of Degos disease. A total of 357 patients were included in the analysis. Mean age of onset was 33.9 years. MAP was most commonly reported (63.8%, n = 228/357), with 56.6% (n = 129/228) mortality. Cutaneous lesions were usually asymptomatic (26.3%, n = 81/308) and localized to the trunk (57.7%, n = 206/357) and extremities (56.8%, n = 203/357). Systemic involvement developed within 2 years on average, ranging from 0 to 28 years. Anti-platelet monotherapy had a complete resolution rate of 42.3% (n = 11/26) in BAP and 20.0% (n = 7/35) in MAP. Based on the findings of the study, most cases of Degos disease are malignant with high mortality, and even benign cutaneous cases may develop systemic disease in as late as 28 years. Anti-platelet monotherapies may prove effective against both variants. Further studies are needed to confirm these findings.
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Affiliation(s)
- P J Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Y Lytvyn
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - N Kashetsky
- Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - A Bagit
- Faculty of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - A Mufti
- Department of Dermatology, University of Toronto, Toronto, ON, Canada
| | - J Yeung
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Dermatology, University of Toronto, Toronto, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada
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Guo YF, Pan WH, Cheng RH, Yu H, Liao WQ, Yao ZR. Successful treatment of neurological malignant atrophic papulosis in child by corticosteroid combined with intravenous immunoglobulin. CNS Neurosci Ther 2014; 20:88-91. [PMID: 24341936 DOI: 10.1111/cns.12196] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 09/23/2013] [Accepted: 09/24/2013] [Indexed: 01/09/2023] Open
Affiliation(s)
- Yi-Feng Guo
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Karaoğlu P, Topçu Y, Bayram E, Yis U, Akarsu S, Atalay E, Koroğlu T, Cakmakçi H, Ozer E, Hız S. Severe neurologic involvement of Degos disease in a pediatric patient. J Child Neurol 2014; 29:550-4. [PMID: 23400246 DOI: 10.1177/0883073812474692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 14-year-old male presented with paresthesias on the right upper and lower extremities, headache, and vomiting. In addition to worsening paresthesia and weakness on the right side of his body, blurred vision, fever, and skin lesions developed. He also had skin lesions characterized with 3-10 mm papules with a white atrophic center surrounded by pink rim mostly on the trunk and lower extremities. Brain magnetic resonance imaging showed chronic subdural effusion and encephalomalacia of the left cerebral hemisphere. Cerebrospinal fluid (CSF) examination revealed increased protein levels. Electromyography was consistent with diffuse polyradiculoneuropathy. Skin biopsy confirmed the diagnosis of a rare vasculopathy: Degos disease. A case presenting with chronic subdural effusion, encephalomalacia, elevated CSF protein, and polyradiculopathy should be carefully examined for skin lesions, which may suggest the diagnosis of Degos disease.
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Affiliation(s)
- Pakize Karaoğlu
- 1Department of Pediatric Neurology, Dokuz Eylul University Medical School, Izmir, Turkey
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Su Z, Lu Y, Ge Y, Jiang J, Jia Z, Zhu F, Zhang M, Ji C, Tang Y, Wei J, Gao Q, Wang H. Central nervous system involvement in systemic malignant atrophic papulosis (Degos disease): a case report. Int J Dermatol 2013; 54:699-703. [PMID: 23786159 DOI: 10.1111/ijd.12123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/05/2012] [Accepted: 12/09/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Zhonglan Su
- Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine; Medical School of Nanjing Universityg; Nanjing China
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Yan Lu
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Yixin Ge
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Jieyao Jiang
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Zhenyu Jia
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Feng Zhu
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Meihua Zhang
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Chao Ji
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Yicheng Tang
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Jiwu Wei
- Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine; Medical School of Nanjing Universityg; Nanjing China
| | - Qian Gao
- Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine; Medical School of Nanjing Universityg; Nanjing China
| | - Hongwei Wang
- Center for Translational Medicine and Jiangsu Key Laboratory of Molecular Medicine; Medical School of Nanjing Universityg; Nanjing China
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Gutiérrez-Pascual M, Hernández-Martín A, Colmenero I, García-Peñas JJ, López-Pino MA, Torrelo A. Malignant atrophic papulosis: a case report with severe visual and neurological impairment. Pediatr Dermatol 2011; 28:302-5. [PMID: 21133995 DOI: 10.1111/j.1525-1470.2010.01287.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Malignant atrophic papulosis, or Degos' disease, is a severe systemic vasculopathy extremely rare in children. The skin, gastrointestinal tract, and central nervous system are most frequently affected. We report a 5-year-old girl with malignant atrophic papulosis who presented with widespread skin lesions from early infancy and severe visual and neurological impairment.
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Gupta S, Dogra S, Saikia UN, Yadav S, Kanwar AJ. Degos Disease with Dermatomyositis-like Phenomenon: A Diagnostic Dilemma and a Therapeutic Challenge. J Cutan Med Surg 2011; 15:162-6. [DOI: 10.2310/7750.2011.10035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Degos disease is a type of vasculopathy characterized by progressive occlusion of small-sized blood vessels primarily involving the skin, gastrointestinal system, and central nervous system as well as various other systems. Owing to the rarity of the condition, the diagnosis is often a challenge; consequently, management is even more difficult owing to the paucity of experience and literature for the effective treatment of this entity. Case Presentation: We report a case of a 50-year-old male patient with classic skin lesions and rapidly progressive fatal clinical course involving multiple organs associated with dermatomyositis-like features. Therapeutic challenge in such a case of secondary Degos disease with multiorgan dysfunction is discussed. Conclusion: Secondary Degos disease with underlying multisystem dysfunction is a rapidly fatal disease. The patient must be thoroughly investigated to watch for systemic involvement and aggressively treated preferably with antiplatelet drugs and immunosuppresants so as to moderate the severity of the disease. Corticosteroids are best avoided to prevent gastrointestinal perforation.
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Affiliation(s)
- Suruchi Gupta
- From the Departments of Dermatology, Venereology and Leprology and Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- From the Departments of Dermatology, Venereology and Leprology and Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Nahar Saikia
- From the Departments of Dermatology, Venereology and Leprology and Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Yadav
- From the Departments of Dermatology, Venereology and Leprology and Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amrinder J. Kanwar
- From the Departments of Dermatology, Venereology and Leprology and Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Three unusual mimics of primary angiitis of the central nervous system. Rheumatol Int 2010; 32:737-42. [PMID: 21161532 DOI: 10.1007/s00296-010-1679-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 11/14/2010] [Indexed: 11/27/2022]
Abstract
To present three rare mimics of primary angiitis of the central nervous system (PACNS). We describe 3 patients with rare diseases that can mimic PACNS at clinical presentation and neuroimaging. We describe the clinical course of these patients and also present a review of the literature regarding these three diagnoses. All 3 patients presented with neurological symptoms and had abnormal findings on neuroimaging suggestive of PACNS. After detailed history, careful review of systems, thorough laboratory workup and consideration of lack of a response to immunosuppressive therapy, PACNS was ruled out with identification of an alternative diagnosis. PACNS is a rare disease and a diagnostic challenge with many differentials. A thorough investigation and awareness of unusual disorders is critical in avoiding misdiagnosis.
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A case of Degos disease successfully treated with corticosteroid combined with cyclophosphamide. Rheumatol Int 2010; 32:2169-73. [DOI: 10.1007/s00296-010-1436-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Accepted: 03/12/2010] [Indexed: 11/26/2022]
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Mydlarski PR, Barber DF, Robertson LH. Painless pink papules with central porcelain-white scars. CMAJ 2009; 179:1171-3. [PMID: 19015568 DOI: 10.1503/cmaj.080373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- P Régine Mydlarski
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alta
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Abstract
PURPOSE OF REVIEW The skin is often a mirror for matters of internal diseases including disorders of the gastrointestinal tract. Here we enumerate many cutaneous and gastrointestinal associations and focus closely on three of the lesser known cutaneous manifestations of colonic disorders. RECENT FINDINGS Muir-Torre syndrome involves cutaneous sebaceous adenomas and internal malignancy; screening of cutaneous lesions for microsatellite instability, and absence of mismatch repair genes provides an opportunity for diagnosis of the syndrome. Degos' disease is a vasoocclusive disorder involving the cutaneous and gastrointestinal systems; this disease affects all ages with significant mortality, yet a benign variant only affecting the skin is described. Anecdotally reported treatments are listed. Metastatic Crohn's disease is the development of noncaseating granulomas at skin sites not contiguous with the gastrointestinal tract; cutaneous lesions may precede the onset of colonic disease or appear in the absence of active bowel disease, and extensive surgical debridement of perineal lesions is often necessary. SUMMARY Knowledge of these cutaneous manifestations provides an insight into the state of colonic health. These clues alert the clinician to the potential for life-threatening consequences, which leads to vigilant screening and hopefully earlier diagnosis.
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