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Konovalova AM, Pechkurov DV, Tyazheva AA. Chronic Diarrhea as a Debut Manifestation of Crohn’s Disease in Infant: Clinical Case. CURRENT PEDIATRICS 2023. [DOI: 10.15690/vsp.v22i1.2518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Background. Chronic diarrhea can be a symptom of a wide variety of diseases, either of which requires special therapy approaches. The diagnosis of rare causes of chronic diarrhea is especially difficulty as it may be associated with inflammatory bowel disease (IBD) with very early (under 1 year of age) debut.Clinical case description. Boy E. had chronic diarrhea manifested on the first year of life. Ulcerative colitis was diagnosed at the age of 1.5 years, then the diagnosis was changed to Crohn’s disease at the age of 2.5 years. The results of 6-years-follow-up of the patient were presented, as well as analysis of diagnosis and treatment difficulties was carried out.Conclusion. The clinical case of Crohn’s disease with diarrhea as the leading clinical manifestation at the disease onset is described. Sequential diagnostic search allowed us to establish the diagnosis of IBD and to exclude other causes of chronic diarrhea that determined the correct therapeutic strategy.
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Quddusi FI, Youssef MJ, Davis DMR. Dermatologic Manifestations of Systemic Diseases in Childhood. Pediatr Rev 2021; 42:655-671. [PMID: 34850179 DOI: 10.1542/pir.2020-000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Molly J Youssef
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Dawn Marie R Davis
- Department of Pediatric and Adolescent Medicine.,Department of Dermatology, Mayo Clinic, Rochester, MN
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Crouse L, McShane D, Morrell DS, Wu EY. Pyoderma gangrenosum in an infant: A case report and review of the literature. Pediatr Dermatol 2018; 35:e257-e261. [PMID: 29656404 DOI: 10.1111/pde.13471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pyoderma gangrenosum is a neutrophilic dermatosis that is rare in infancy, with only 20 cases reported in the literature. We present a case of infantile pyoderma gangrenosum refractory to topical steroids, tacrolimus, and dapsone as well as systemic steroids and infliximab that is currently well controlled with the addition of oral tacrolimus. To our knowledge, this is the first report of the effective, safe use of oral tacrolimus in combination with infliximab for infantile pyoderma gangrenosum. We review all current cases of infantile pyoderma gangrenosum, as well as tacrolimus and its role in the treatment of this condition.
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Affiliation(s)
- Lauren Crouse
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diana McShane
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dean S Morrell
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eveline Y Wu
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kechichian E, Haber R, Mourad N, El Khoury R, Jabbour S, Tomb R. Pediatric pyoderma gangrenosum: a systematic review and update. Int J Dermatol 2017; 56:486-495. [PMID: 28233293 DOI: 10.1111/ijd.13584] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 12/21/2022]
Abstract
Pyoderma gangrenosum (PG) is a sterile neutrophilic disorder that rarely affects children. Clinical, epidemiological, and therapeutic data on pediatric PG is poor as there are many newly reported associated diseases and drugs. This paper aims to review all recent available data on pediatric PG. A systematic review of the literature was conducted using Embase, Medline, and Cochrane databases. A total of 132 articles were included in the review. The most commonly reported underlying diseases in pediatric PG are inflammatory bowel diseases followed by hematologic disorders, vasculitis, immune deficiencies and Pyogenic Arthritis, Pyoderma gangrenosum and Acne (PAPA) syndrome. More than half of the cases occur with no underlying disease. The most frequently reported clinical presentation is multiple disseminated ulcers. Treatment should be tailored according to the underlying etiology. It includes systemic steroids, corticosteroid sparing agents such as dapsone and cyclosporine, and TNF-alpha inhibitors such as adalimumab and infliximab. Response to treatment is high with cure rates reaching 90%. A high index of suspicion and a thorough workup are mandatory in the management of pediatric PG.
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Affiliation(s)
- Elio Kechichian
- Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Roger Haber
- Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Nadim Mourad
- Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Rana El Khoury
- Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Samer Jabbour
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Plastic and Reconstructive Surgery, Hotel Dieu de France University Hospital, Beirut, Lebanon
| | - Roland Tomb
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Chief of Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon
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Abstract
Three healthy children with an anogenital skin eruption, all of whom had undergone extensive medical evaluation and treatment, had undetected intestinal Crohn's disease. Biopsy of the skin showed noncaseating granulomas consistent with cutaneous Crohn's disease. Inflammatory bowel disease should be in the differential diagnosis of persistent nontender, erythematous papules, nodules, and plaques in the anogenital region.
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Rajan N, Das S, Taylor A, Abinun M, Spencer D, Carmichael A. Idiopathic infantile pyoderma gangrenosum with stridor responsive to infliximab. Pediatr Dermatol 2009; 26:65-9. [PMID: 19250410 DOI: 10.1111/j.1525-1470.2008.00825.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 4-month-old female infant presented with widespread pyoderma gangrenosum associated with stridor, presumed secondary to tracheal involvement. No underlying cause was revealed despite extensive investigation. Treatment with immunosuppressive agents only partially suppressed disease activity. Complete resolution followed treatment with infliximab. We review this rare condition in infants and discuss treatment with infliximab not previously described in this age group.
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Affiliation(s)
- Neil Rajan
- Department of Dermatology, The James Cook University Hospital, Middlesbrough, UK.
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McAleer MA, Powell FC, Devaney D, O'Donnell BF. Infantile pyoderma gangrenosum. J Am Acad Dermatol 2008; 58:S23-8. [DOI: 10.1016/j.jaad.2007.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 06/03/2007] [Accepted: 08/09/2007] [Indexed: 01/01/2023]
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