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McKay GE, Liu L, Shaw KS, Shakshouk H, Murphy MJ, Damsky W, Ortega-Loayza AG, Caplan AS, Arkin LM, Shields BE. Pediatric cutaneous Crohn disease: A case series of 89 patients and review. Pediatr Dermatol 2024. [PMID: 39011834 DOI: 10.1111/pde.15689] [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: 09/20/2023] [Accepted: 06/16/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Cutaneous (or "Metastatic") Crohn disease (CCD) is a rare and underrecognized disease characterized by cutaneous granulomatous inflammation. We describe patient demographics, clinical characteristics, histology, and treatment of 89 pediatric cases of CCD, including 78 previously reported and 11 new cases seen at four academic institutions. We emphasize the efficacy of biologic mono- and dual therapy. METHODS PubMed identified cases using keywords including "metastatic Crohn disease" and "cutaneous Crohn disease". Patients were identified by retrospective review of the electronic health record including histopathologic diagnosis consistent with CCD. Chart review collected demographic, clinical, and histologic data. RESULTS Most pediatric patients with CCD are male 55% (49/89), present with edema (73/89, 82%) and erythema (47/89, 53%) of the genitals (33/49, 67%), and have intestinal Crohn disease (69/89, 78%). Oral corticosteroids (53/75, 71%) and metronidazole (29/75, 39%) are the most frequently prescribed medications. Of the 17 patients treated with tumor necrosis factor (TNF)-blockade, 94% (16/17) had partial or total clearance. Ustekinumab resulted in clearance of cutaneous disease in two patients (2/3, 67%) and partial clearance in one patient (1/3, 33%). Two cases achieved total clearance with the use of dual biologic therapy defined as the use of two biologic therapies with differing mechanisms of action or the use of a biologic therapy and small molecule inhibitor. CONCLUSIONS TNF blockade is an effective treatment for pediatric CCD, and interleukin-12/23 inhibitors may be similarly effective. Consideration of dual biologic therapy may be useful in pediatric patients requiring discordant therapies for their intestinal and cutaneous CD.
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Affiliation(s)
- Grace E McKay
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lynn Liu
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Katharina S Shaw
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hadir Shakshouk
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Michael J Murphy
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
| | - William Damsky
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Avrom S Caplan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Bridget E Shields
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Esfandiari N, Vandyke S, Porter HJ, Shea K, Morley K, Greene L. A case of mevalonate kinase deficiency, neonatal Sweet syndrome, and inflammatory bowel disease. Pediatr Dermatol 2024; 41:298-301. [PMID: 37807602 DOI: 10.1111/pde.15432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023]
Abstract
Mevalonate kinase deficiency is a group of rare metabolic autoinflammatory disorders that present with recurrent fevers, abdominal pain, arthralgias, adenopathy, and a variety of cutaneous manifestations. The skin findings may mimic cellulitis, erythema elevatum diutinum, IgA vasculitis, and Sweet syndrome, and there is often a morbilliform or urticarial rash and aphthous stomatitis. Mevalonate kinase deficiency is one of the identified monogenic variants that can cause very early onset inflammatory bowel disease (IBD). We present a rare case of a patient with mevalonate kinase deficiency, neonatal Sweet syndrome, and infantile-onset IBD, who has been successfully treated with canakinumab therapy.
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Affiliation(s)
- Negar Esfandiari
- Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA
| | - Santana Vandyke
- Division of Dermatology, The University of Vermont Medical Center, Burlington, Vermont, USA
| | - Hannah J Porter
- Division of Dermatology, The University of Vermont Medical Center, Burlington, Vermont, USA
| | - Katelyn Shea
- Four Seasons Dermatology, Colchester, Vermont, USA
| | - Keith Morley
- Division of Dermatology, The University of Vermont Medical Center, Burlington, Vermont, USA
| | - Laura Greene
- Department of Pathology and Laboratory Medicine, The University of Vermont Medical Center, Burlington, Vermont, USA
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Brioso XB, Banks D, Christison-Lagay E, Phatak UP, Vash-Margita A. Vulvovaginal Complaints as the First Manifestation of Crohn's Disease in Children: Case Report. J Pediatr Adolesc Gynecol 2023; 36:494-496. [PMID: 37196754 DOI: 10.1016/j.jpag.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Crohn's disease, a chronic gastrointestinal inflammatory condition, can involve gynecological structures. Rectovaginal or rectovestibular involvement may be the first sign in the pediatric population and may result in delayed diagnosis and treatment. CASE A 9-year-old premenarchal female with chronic constipation and poor growth presented to the pediatric gynecologist for evaluation of persistent vulvovaginal discharge and vulvar irritation. Examination under anesthesia revealed a rectolabial fistula; colonoscopy was diagnostic of Crohn's disease. Immunotherapy resulted in improvement of symptoms and anatomical changes. SUMMARY AND CONCLUSION In cases of persistent vulvar complaints in a child without clear diagnosis, a high index of suspicion for a non-gynecologic diagnosis is necessary. Collaboration between pediatric gynecologists, gastroenterologists, and surgeons can result in prompt diagnosis and treatment of genital Crohn's disease.
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Affiliation(s)
- Xiomara B Brioso
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, Connecticut
| | - Darnna Banks
- Department of Gastroenterology, Hepatology, and Nutrition, Yale New Haven Hospital, New Haven, Connecticut
| | | | - Uma P Phatak
- Department of Gastroenterology, Hepatology, and Nutrition, Yale New Haven Hospital, New Haven, Connecticut
| | - Alla Vash-Margita
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, Connecticut.
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Sechi A, Patrizi A, Vara G, Golfieri R, Neri I. Bei CALME (childhood asymmetry labium majus enlargement): die Ruhe bewahren und nachverfolgen. J Dtsch Dermatol Ges 2021; 19:1276-1282. [PMID: 34541793 DOI: 10.1111/ddg.14528_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Abstract
CALME steht für childhood asymmetry labium majus enlargement und bezeichnet eine physiologische, nichtneoplastische Schwellung des Weichteilgewebes der Labia majora. CALME wird durch die Vergrößerung einer oder mehrerer normaler vulvärer Gewebeanteile verursacht und weist keine äußere Kapsel auf. Vereinzelte Berichte in der Literatur haben das Augenmerk auf diese gutartige Veränderung gelenkt und die Notwendigkeit betont, invasive Eingriffe mit möglichen Dauerfolgen zu vermeiden. Die Ätiopathogenese von CALME ist nach wie vor umstritten, wobei die Hypothese einer hormonell bedingten stromalen Hyperplasie der großen Schamlippen gegenüber der Annahme eines gutartigen neoplastischen Prozesses favorisiert wird. Dieser Artikel zielt darauf ab, einen detaillierten Überblick über die klinischen, histologischen und apparativen Befunde bei CALME zu geben und einen abgestuften Algorithmus zur Herangehensweise und zum Management von genito-inguinalen Geschwülsten bei pädiatrischen Patienten zu erstellen.
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Affiliation(s)
- Andrea Sechi
- IRCCS University Hospital of Bologna St. Orsola-Malpighi Polyclinic Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- IRCCS University Hospital of Bologna St. Orsola-Malpighi Polyclinic Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulio Vara
- Radiology Unit, University Hospital of Bologna St. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, University Hospital of Bologna St. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Iria Neri
- IRCCS University Hospital of Bologna St. Orsola-Malpighi Polyclinic Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Kim S, Won YB, Seo SK, Cho S, Choi YS, Lee BS, Yun BH. Vulvar Crohn's disease in an adolescent diagnosed after unsuccessful surgical treatment. BMC Womens Health 2021; 21:316. [PMID: 34454474 PMCID: PMC8399794 DOI: 10.1186/s12905-021-01449-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/10/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND This case report presents a case of Vulvar Crohn's disease (VCD) in an adolescent, that is an uncommon manifestation of Crohn's disease (CD) without gastrointestinal symptoms. Before treating CD itself with proper medication, vulvar abscess continued to recur without improvement. CASE PRESENTATION We report the case of an 18-year-old woman with VCD. After treatment with azathioprine 50 mg daily and mesalazine 1 g three times daily, vulvar lesions resolved after 6 weeks. We collected electronic medical data on patient characteristics, and evaluated findings of physical examinations, pelvic MRI, and biopsy specimen obtained from gastroduodenoscopy/colonoscopy. CONCLUSIONS VCD is a rare manifestation of CD that may be misdiagnosed in the absence of gastrointestinal symptoms leading to delayed treatment. If a patient has an unexplained vulvar inflammatory lesion and with repeated failed surgical treatment, gynecologists should consider the possibility of a VCD.
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Affiliation(s)
- Suhra Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Bin Won
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - SiHyun Cho
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Sik Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Seok Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea.
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Sechi A, Patrizi A, Vara G, Golfieri R, Neri I. Keep CALME (childhood asymmetry labium majus enlargement) and follow up. J Dtsch Dermatol Ges 2021; 19:1276-1281. [PMID: 34164912 DOI: 10.1111/ddg.14528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
CALME is the abbreviation of "childhood asymmetry labium majus enlargement" and denotes a physiological, non-neoplastic swelling of labium majus soft tissues. It is caused by the expansion of one or more normal vulvar tissue components and is devoid of a peripheral capsule. A few reports in the literature have raised awareness of this benign condition and stressed the need to avoid invasive procedures with possible permanent sequelae. The etiopathogenesis of CALME is still debated, although the hypothesis of a hormone-driven major labia stromal hyperplasia is favored over the assumption of a benign neoplastic process. This article aims to provide a detailed review of the clinical, histological, and instrumental findings of CALME and provide a step-based algorithm to approach and manage genito-inguinal masses in pediatric patients.
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Affiliation(s)
- Andrea Sechi
- IRCCS University Hospital of Bologna St. Orsola-Malpighi Polyclinic Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- IRCCS University Hospital of Bologna St. Orsola-Malpighi Polyclinic Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulio Vara
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, Bologna, Italia
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, Bologna, Italia
| | - Iria Neri
- IRCCS University Hospital of Bologna St. Orsola-Malpighi Polyclinic Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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7
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Ducharme O, Schollhammer R, Leduc J, Baubion E, Farid K, Amazan E. Lymphatic drainage abnormalities in a child presenting as an unilateral vulvar swelling: a case of 'Bicyclist's vulva'. J Eur Acad Dermatol Venereol 2019; 34:e171-e173. [PMID: 31785098 DOI: 10.1111/jdv.16117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- O Ducharme
- Department of Dermatology, CHU Martinique, Fort-De-France, Martinique
| | - R Schollhammer
- Department of Nuclear Medicine, CHU Martinique, Fort-De-France, Martinique
| | - J Leduc
- Department of Dermatology, CHU Martinique, Fort-De-France, Martinique
| | - E Baubion
- Department of Dermatology, CHU Martinique, Fort-De-France, Martinique
| | - K Farid
- Department of Nuclear Medicine, CHU Martinique, Fort-De-France, Martinique
| | - E Amazan
- Department of Dermatology, CHU Martinique, Fort-De-France, Martinique
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