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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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Burningham KM, Verma KK, Patel AB, Tyring SK. Resolution of metastatic cutaneous Crohn's disease with upadacitinib monotherapy. JAAD Case Rep 2024; 46:81-84. [PMID: 38577495 PMCID: PMC10992270 DOI: 10.1016/j.jdcr.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
| | - Kritin K. Verma
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Anisha B. Patel
- Department of Dermatology, the University of Texas Health Science Center at Houston, Bellaire, Texas
- Department of Dermatology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen K. Tyring
- Center for Clinical Studies, Ltd., Webster, Texas
- Department of Dermatology, the University of Texas Health Science Center at Houston, Bellaire, Texas
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3
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Yi LG, Valluri AP, Rincon JD, Raghavan S, Zlotoff BJ. Violaceous papules on the limbs of a 10-year-old girl. Pediatr Dermatol 2024. [PMID: 38444100 DOI: 10.1111/pde.15573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Lauren G Yi
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Anisha P Valluri
- Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia, USA
| | - Juanita Duran Rincon
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Shyam Raghavan
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Barrett J Zlotoff
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
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Mahajan R, Bishnoi A, Gupta S, Manjunath S, Kumar Bhatia A, De D, Handa S. An unusual cause of inguinal ulceration - dystrophic epidermolysis bullosa. Indian J Dermatol Venereol Leprol 2024; 0:1-2. [PMID: 38595009 DOI: 10.25259/ijdvl_917_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/21/2023] [Indexed: 04/11/2024]
Affiliation(s)
- Rahul Mahajan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Smriti Gupta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Seema Manjunath
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anoop Kumar Bhatia
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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5
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Plaques and skin ulcers in a child with inflammatory bowel disease: A diagnostic challenge. J Paediatr Child Health 2023; 59:1335. [PMID: 38073247 DOI: 10.1111/jpc.1_16315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/28/2022] [Accepted: 12/14/2022] [Indexed: 12/18/2023]
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Ashworth J, Freitas E, Coelho A, Ferreira-Magalhães M, Machado S. Plaques and skin ulcers in a child with inflammatory bowel disease: A diagnostic challenge. J Paediatr Child Health 2023; 59:1331-1332. [PMID: 36562608 DOI: 10.1111/jpc.16315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/28/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Joanna Ashworth
- Paediatrics Department, Centro Materno-Infantil do Norte (CMIN) - Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - Egídio Freitas
- Dermatology Department, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - André Coelho
- Pathology Department, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - Manuel Ferreira-Magalhães
- Paediatrics Department, Centro Materno-Infantil do Norte (CMIN) - Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
- CINTESIS - Centre for Health Technologies and Information Systems Research - Faculty of Medicine, University of Porto, Porto, Portugal
| | - Susana Machado
- Dermatology Department, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
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7
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Raman LG, AbdullGaffar B. Metastatic Crohn disease revealing vascular embolization: Report of two cases. J Cutan Pathol 2023; 50:929-932. [PMID: 37622172 DOI: 10.1111/cup.14521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
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8
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An Y, Liu L, Wu R, Mu Q. Vulva involvement of metastatic Crohn's disease: A rare and easily ignored clinical finding. Asian J Surg 2023; 46:4846-4847. [PMID: 37328372 DOI: 10.1016/j.asjsur.2023.05.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/25/2023] [Indexed: 06/18/2023] Open
Affiliation(s)
- Yuepan An
- Department of Gynaecology, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, 010020, China
| | - Li Liu
- Department of Dermatology, International Mongolian Hospital of Inner Mongolia, Hohhot, 010020, China
| | - Rina Wu
- Department of Dermatology, International Mongolian Hospital of Inner Mongolia, Hohhot, 010020, China
| | - Qiri Mu
- Department of Dermatology, International Mongolian Hospital of Inner Mongolia, Hohhot, 010020, China.
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Alotaibi HM, Fathaddin AA, AlMutairi HM, Barakeh MM. Metastatic Crohn's Disease in External Genitalia With Good Outcome on Adalimumab: A Rare Case of a Saudi Female and a Short Review. Cureus 2023; 15:e43380. [PMID: 37700991 PMCID: PMC10494988 DOI: 10.7759/cureus.43380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/14/2023] Open
Abstract
Crohn's disease (CD), an inflammatory bowel disease that involves the gastrointestinal tract, is observed in daily hospital practice. On the other hand, metastatic Crohn's disease (MCD) is a rare entity in which cutaneous lesions are found in regions apart from the digestive system. This article describes a rare case of cutaneous CD in a Saudi female, which manifested initially as vulvar and perianal skin lesions. The diagnosis was proven by skin biopsy, and adalimumab offered effective treatment. Although cutaneous MCD is rare, it is an important cutaneous manifestation, as early detection creates the possibility of accessing effective management.
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10
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Beysens S, Wellens J, De Hertogh G, Van Laethem A, Sabino J, Hillary T, Vermeire S. Managing metastatic Crohn's disease: a single center experience, review of the current evidence, and treatment algorithm. Scand J Gastroenterol 2023; 58:1122-1130. [PMID: 37178009 DOI: 10.1080/00365521.2023.2209689] [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: 02/09/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Crohn's disease (CD) is an inflammatory bowel disease (IBD) that, besides gastrointestinal symptoms, may encompass extra-intestinal symptoms, such as dermatological manifestations. Of those, metastatic CD (MCD) is a rare extra-intestinal manifestation for which the management is uncertain. METHODS We conducted a retrospective case series of patients with MCD seen at the University hospital Leuven, Belgium, combined with an overview of the recent literature. Electronic medical records were searched from January 2003 till April 2022. For the literature search, Medline, Embase, Trip Database, and The Cochrane Library were searched from inception to April 1, 2022. RESULTS A total of 11 patients with MCD were retrieved. In all cases noncaseating granulomatous inflammation was found on skin biopsies. Two adults and one child were diagnosed with MCD prior to their diagnosis of CD. Seven patients were treated with steroids (intralesional, topical or systemic). Six patients needed a biological therapy to treat MCD. Surgical excision was performed in three patients. All patients reported a successful outcome and most cases achieved remission. The literature search yielded 53 articles, including three reviews, three systematic reviews, 30 case reports and six case series. A treatment algorithm was generated based on literature and multidisciplinary discussion. CONCLUSION MCD remains a rare entity and diagnosis is often difficult. A multidisciplinary approach including skin biopsy is necessary to diagnose and treat MCD efficiently. Outcome is generally favorable, and lesions respond well to steroids and biologicals. We propose a treatment algorithm based on the available evidence and multidisciplinary discussion.
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Affiliation(s)
- S Beysens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - J Wellens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
| | - G De Hertogh
- KU Leuven Department of Imaging and Pathology, Translational Cell and Tissue Research Unit, Leuven, Belgium
| | - A Van Laethem
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - J Sabino
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
| | - T Hillary
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - S Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
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Necrobiosis lipoidica of the breast associated with Crohn's disease: a case report. J Med Case Rep 2023; 17:1. [PMID: 36597169 PMCID: PMC9811805 DOI: 10.1186/s13256-022-03698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/25/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Necrobiosis lipoidica located to the breast; without evidence of glucose intolerance, is extremely rare, and its association to Crohn's disease is not usual. CASE PRESENTATION We report an interesting case of an association of necrobiosis lipoidica of the breast and Crohn's disease in a 54-year-old Moroccan woman. Skin necrobiotic changes are a characteristic feature in necrobiosis lipoidica, but they are exceptional in metastatic Crohn's disease, since there are only three published cases of necrobiotic skin lesions on the lower leg resembling erythema nodosum in metastatic Crohn's disease. CONCLUSIONS On the basis of this rare observation, necrobiosis lipoidica without evidence of glucose intolerance should be recognized as a possible cutaneous manifestation or association of Crohn's disease.
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12
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Kinberger M, Bonnekoh H, Dilling A, Meier K. [Granulomatous dermatoses]. Z Rheumatol 2022; 81:577-586. [PMID: 35854155 DOI: 10.1007/s00393-022-01239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/26/2022]
Abstract
The group of granulomatous dermatoses refers to a multitude of clinically different diseases, which are characterized by a histopathologically similar pattern of inflammation. The cause of granulomatous inflammatory reactions can be infections and also noninfectious stimuli, such as cell disintegration or foreign bodies. The aim of this immunological defence reaction is encapsulation in order to prevent further spread and delimitation from healthy tissue. This is histologically expressed as a granuloma in the sense of a circumscribed aggregation of histiocytes and multinucleated giant cells mostly in dermal connective tissue. The following can be histologically differentiated: sarcoid granuloma characterized by a sparse lymphocytic inflammatory infiltrate and tuberculous granuloma with central necrosis and denser lymphocytic inflammatory infiltrate. Neutrophilic granulocytes together with macrophages occur in suppurative granulomas and palisaded granulomas are characterized by peripherally arrayed macrophages.
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Affiliation(s)
- Maria Kinberger
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Hanna Bonnekoh
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Amrei Dilling
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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13
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Fradkov E, Sheehan J, Cushing K, Higgins PDR. Efficacy of Ustekinumab in Crohn's Disease With and Without Concurrent Autoimmune Skin Disease. Inflamm Bowel Dis 2022; 28:895-904. [PMID: 34591972 DOI: 10.1093/ibd/izab201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Approximately 33% of Crohn's disease (CD) patients have associated autoimmune skin disease. The pathophysiology of the latter frequently involves interleukin-12/interleukin-23 signaling pathways that may also impact gut inflammation. Ustekinumab is an anti-IL-12/23 FDA-approved biologic for psoriasis and inflammatory bowel disease. However, its relative efficacy has never been studied in CD with autoimmune skin disease (CD-ASD) vs CD without autoimmune skin disease (CD-none). METHODS This is a retrospective, single-center, case-control study comparing markers of disease activity between CD-ASD and CD-none. Biomarkers (fecal calprotectin [FCP], C-reactive protein [CRP]) prior to drug initiation and after at least 5 months of standard IBD dose ustekinumab therapy were extracted from the medical record. In addition, 2 blinded observers performed 5-point Likert scoring before and after endoscopic, pathologic, and imaging reports. RESULTS In all, 395 CD patients received ustekinumab therapy (79 CD-ASD, 316 CD-none). Patients were similar in age; gender; ethnicity; CD severity, phenotype, and duration; tobacco, immunomodulator, and steroid use. Ustekinumab had greater efficacy in CD-ASD when evaluated by FCP (P = .0337) and CRP (P = .078). The CD-ASD group also showed better outcomes in Likert scores of endoscopy (P = .016), histopathology (P = .074), and imaging (P = .094). In all Likert parameters, CD-ASD had more patients with complete resolution of moderate/severe disease (P < .05). Additional subanalyses for surgeries, ulcers, abscesses, fistulas, and colitis were conducted, with colitis reaching statistical significance (P = .0011). CONCLUSIONS Concurrent autoimmune skin disease in CD is associated with greater ustekinumab effectiveness in controlling intestinal inflammation.
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Affiliation(s)
- Elena Fradkov
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica Sheehan
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly Cushing
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter D R Higgins
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Cobb CBC, Caravaglio JV, Qureshi AA, Robinson‐Bostom L. Concominant Bullous Pemphigoid and Cutaneous Crohn Disease. J Cutan Pathol 2022; 49:579-583. [DOI: 10.1111/cup.14206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 01/05/2022] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Caryn B. C. Cobb
- Department of Dermatology Warren Alpert Medical School of Brown University, 593 Eddy Street, Ambulatory Patient Care Building, 10th Floor Providence Rhode Island
| | - Joseph V. Caravaglio
- Department of Dermatology Warren Alpert Medical School of Brown University, 593 Eddy Street, Ambulatory Patient Care Building, 10th Floor Providence Rhode Island
| | - Abrar A. Qureshi
- Department of Dermatology Warren Alpert Medical School of Brown University, 593 Eddy Street, Ambulatory Patient Care Building, 10th Floor Providence Rhode Island
| | - Leslie Robinson‐Bostom
- Department of Dermatology Warren Alpert Medical School of Brown University, 593 Eddy Street, Ambulatory Patient Care Building, 10th Floor Providence Rhode Island
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15
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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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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena M, Christian Laga A, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín J, Ríos-Viñuela E, Rodríguez Peralto J, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda J, Velasco Benito V, Beato Merino M, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses - Part 1. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Letzelter M, Andrianjafy C, Marin S, Rocour S, De Ybarlucea LR, Maillard H. [Metastatic Crohn's disease of the umbilicus: An exceptional location]. Rev Med Interne 2021; 43:54-56. [PMID: 34362570 DOI: 10.1016/j.revmed.2021.07.006] [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: 05/15/2021] [Revised: 06/23/2021] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cutaneous manifestations of Crohn's disease are frequent and include metastatic lesions. These are separated from the digestive tract and affect particularly the limbs and major folds. Umbilical involvement is exceptional. CASE REPORT A 93-year-old woman followed for 6 years for Crohn's disease, in remission on infliximab, 5mg/kg every 8 weeks, consulted for a fissured and painful omphalitis. Histology revealed epithelioid granulomas without necrosis in the dermis, leading to the diagnosis of umbilical cutaneous metastasis of Crohn's disease. Infliximab intensification every 6 weeks led to a positive outcome. CONCLUSION We report a unique case of umbilical metastatic localization of Crohn's disease occurring during treatment with anti-TNF alpha. The diagnosis was based on skin biopsy and histology which found epithelioid granulomas without caseous necrosis.
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Affiliation(s)
- M Letzelter
- Service de dermatologie, Centre hospitalier Le Mans, 194, avenue Rubillard, 72037 Le Mans.
| | - C Andrianjafy
- Service d'hépato-gastro-entérologie, Centre hospitalier le Mans, 194, avenue Rubillard, 72037 Le Mans
| | - S Marin
- Service d'hépato-gastro-entérologie, Centre hospitalier le Mans, 194, avenue Rubillard, 72037 Le Mans
| | - S Rocour
- Service d'anatomopathologie, Centre hospitalier Le Mans, 194, avenue Rubillard, 72037 Le Mans
| | - L-R De Ybarlucea
- Service d'anatomopathologie, Centre hospitalier Le Mans, 194, avenue Rubillard, 72037 Le Mans
| | - H Maillard
- Service de dermatologie, Centre hospitalier Le Mans, 194, avenue Rubillard, 72037 Le Mans
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Genital and Intertriginous Rashes Refractory to Antimicrobial Treatments: Have You Thought about Crohn's Disease? Case Rep Pediatr 2021; 2021:5578810. [PMID: 34336339 PMCID: PMC8324389 DOI: 10.1155/2021/5578810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Crohn's disease is an inflammatory bowel disease that can have multiple extraintestinal manifestations and can develop prior to, following, or simultaneously with gastrointestinal tract involvement (Aberumand et al. (2017), Georgious et al. (2006), Larsen et al. (2010), Levine and Burakoff (2011), Louis et al. (2018)). This report examines the case of a 16-year-old male with a rash of the genital, intergluteal, and inguinal regions refractory to antimicrobial treatments suspicious for an extraintestinal manifestation of Crohn's disease. The patient was diagnosed with inflammatory, nonfistulizing colonic Crohn's disease following presentation with gastrointestinal symptoms including abdominal pain and bloody stools 6 months after the onset of the rash. The genital lesions resolved after starting treatment for Crohn's disease with adalimumab.
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19
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Conover KR, Cox CB, Wang H, Bhatt R, Hafberg ET. Pediatric Metastatic Crohn's Disease of the Liver. JPGN REPORTS 2021; 2:e107. [PMID: 37205958 PMCID: PMC10191507 DOI: 10.1097/pg9.0000000000000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/15/2021] [Indexed: 05/21/2023]
Abstract
Metastatic Crohn's disease (MCD) is the manifestation of Crohn's disease outside of the gastrointestinal tract and most frequently involves mucocutaneous and pulmonary tissues. This is an uncommon phenomenon but is well characterized in the pediatric literature. In contrast, MCD affecting the liver has not previously been described in pediatrics. The pediatric gastroenterologist must be aware of the myriad of Crohn's disease-associated hepatopathies. We herein present the first reported case of pediatric MCD involving the liver and describe our targeted diagnostic evaluation and the patient's response to infliximab-dyyb.
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Affiliation(s)
- Katie R. Conover
- From the Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt
| | - Conrad B. Cox
- From the Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children’s Hospital at Vanderbilt
| | - Huiying Wang
- Division of Pediatric Pathology, Department of Pathology, Microbiology, and Immunology, Monroe Carell Jr. Children’s Hospital at Vanderbilt
| | - Riha Bhatt
- From the Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children’s Hospital at Vanderbilt
| | - Einar T. Hafberg
- From the Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children’s Hospital at Vanderbilt
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20
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A Verrucous Plaque With Linear Fissures in a Patient With Crohn's Disease: Answer. Am J Dermatopathol 2021; 43:461-463. [PMID: 34006733 DOI: 10.1097/dad.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena MÁ, Christian Laga Á, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín JJ, Ríos-Viñuela E, Rodríguez Peralto JL, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz Á, Saus C, Suárez Peñaranda JM, Velasco Benito V, Beato Merino MJ, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses - Part 1. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00139-3. [PMID: 33887235 DOI: 10.1016/j.ad.2021.04.002] [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: 03/20/2021] [Accepted: 04/05/2021] [Indexed: 11/23/2022] Open
Abstract
This series of 2 articles on dermatopathologic diagnoses reviews conditions in which granulomas form. Part 1 clarifies concepts, discusses the presentation of different types of granulomas and giant cells, and considers a large variety of noninfectious diseases. Some granulomatous diseases have a metabolic origin, as in necrobiosis lipoidica. Others, such as granulomatous mycosis fungoides, are related to lymphomas. Still others, such as rosacea, are so common that dermatologists see them nearly daily in clinical practice.
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Affiliation(s)
- J Aróstegui Aguilar
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - R Carrillo Gijón
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Fernández Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Barcelona, España
| | - J Fraga
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - A García Herrera
- Servicio de Anatomía Patológica, Hospital Clinic, Barcelona, España
| | - M Garrido
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - M Á Idoate Gastearena
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Departamento de Citología, Histología y Anatomía Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - Á Christian Laga
- Departamento de Patología, Brigham and Women's Hospital, Boston, EE. UU
| | - M Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - N Martínez Campayo
- Servicio de Dermatología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - J Onrubia
- Servicio de Anatomía Patológica, Hospital Universitario San Juan de Alicante, Alicante, España
| | - N Pérez Muñoz
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Quirón salud, Barcelona, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - J L Rodríguez Peralto
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - E Rozas Muñoz
- Departamento de Dermatología, Hospital de San Pablo, Coquimbo, Chile
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Santonja
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, Madrid, España
| | - Á Santos-Briz
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
| | - C Saus
- Servicio de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - J M Suárez Peñaranda
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - V Velasco Benito
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - M J Beato Merino
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España
| | - A Fernandez-Flores
- Servicio de Anatomía Patológica, Hospital Universitario El Bierzo, Ponferrada, León, España; Servicio de Anatomía Patológica, Hospital de La Reina, Ponferrada, León, España; Unidad de Investigación, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña, A Coruña, España.
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22
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Metastatic Crohn Disease: A Clinicohistological Appraisal From a Tertiary Care Center in India. Am J Dermatopathol 2021; 42:506-512. [PMID: 31693502 DOI: 10.1097/dad.0000000000001543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Granulomatous dermatitis due to noncontiguous involvement of Crohn disease (CD) of the gut has been described as metastatic CD (MCD). MCD is the rarest form of cutaneous manifestations of CD. This study aims to analyze the clinicohistological features of MCD in a tertiary care center of India. MATERIALS AND METHODS A retrospective review of patients diagnosed clinically and histologically with MCD over past 5 years was performed. Data on cutaneous features, histological findings, and response to treatment were collected. RESULTS Twelve patients (3 men and 9 women) with a mean age of 29 years were identified. All women had vulval involvement in the form of edema (80%), ulceration (60%), and fistula (20%). Among the 3 men, 2 had perineal and scrotal swelling and ulcer, whereas the third patient presented with leg ulcer. Intestinal CD was already diagnosed in 50% patients (5/10) at cutaneous presentation, whereas it was diagnosed subsequently in 30% (3/10) cases. Histological examination revealed nonnecrotizing granulomatous inflammation in the dermis in 11 patients (92%). Additional histological features included eosinophilic infiltrate (58%), panniculitis (33%), and vasculitis (33%). The patients were treated with various combinations of oral prednisolone, metronidazole, minocycline, azathioprine, and subcutaneous adalimumab with partial relief. CONCLUSION MCD shows a wide spectrum of clinical presentation, with anogenital involvement being the most common. Histology reveals nonnecrotizing granulomas in the dermis in majority of the cases. The diagnosis is extremely challenging in patients without gastrointestinal involvement at presentation, and thus, a high index of suspicion is imperative.
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Martins Figueiredo L, Oliveira AM, Martins A. Metastatic Cutaneous Crohn's Disease of the Face-A Case Successfully Treated With Ustekinumab. J Crohns Colitis 2020; 14:874-875. [PMID: 31630151 DOI: 10.1093/ecco-jcc/jjz171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | - Ana Maria Oliveira
- Gasroenterology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Alexandra Martins
- Gasroenterology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
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Premjeyanth V, Shipman AR, Shipman KE. Faecal calprotectin in dermatology practice. Clin Exp Dermatol 2020; 45:831-835. [DOI: 10.1111/ced.14307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - A. R. Shipman
- Dermatology Department St Mary’s Hospital Portsmouth UK
| | - K. E. Shipman
- Department of Clinical Chemistry St Richards Hospital Chichester UK
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25
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Streight KL, Braun TL, Lowe N, Kim SJ. A Rare Clinical Presentation of Metastatic Crohn's Disease. Cureus 2020; 12:e8285. [PMID: 32467818 PMCID: PMC7250390 DOI: 10.7759/cureus.8285] [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] [Indexed: 11/05/2022] Open
Abstract
A 31-year-old female with a history of systemic lupus erythematous, IgA nephropathy, and psoriasis presented with a one-month history of a painful, pruritic rash under the bilateral breasts and in the genital region. Cutaneous examination revealed a large, tender ulcer under the left breast with a shiny erythematous base and peripheral hypertrophic changes. Small ulcers were present on the bilateral inguinal folds, and the labia majora were edematous with multiple erythematous papules. Histological examination of the left breast revealed ulceration with granulomatous dermatitis, consistent with a diagnosis of metastatic Crohn's disease. Metastatic Crohn's disease is a rare cutaneous manifestation of Crohn's disease characterized by non-caseating granulomas in regions non-contiguous with the gastrointestinal tract. At the time of diagnosis, our patient reported no gastrointestinal symptoms aside from occasional blood-streaked stools from hemorrhoids. This case demonstrates the importance of considering the disease when a patient presents with intertriginous or genital lesions, even in the absence of systemic manifestations.
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Affiliation(s)
| | - Tara L Braun
- Dermatology, Baylor College of Medicine, Houston, USA
| | - Nicholas Lowe
- Dermatology, Baylor College of Medicine, Houston, USA
| | - Soo Jung Kim
- Dermatology, Baylor College of Medicine, Houston, USA
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Abstract
Granulomatous dermatoses comprise a wide range of etiologically and clinically distinct skin diseases that share a common histology characterized by the accumulation of histiocytes include macrophages. While the pathogenesis of these disorders is not fully understood, the underlying mechanism is thought to involve a reaction pattern caused by an immunogenic stimulus. Antigen-presenting cells and the effect of various cytokines play a key role. Our understanding of granulomatous reaction patterns has been advanced by insights drawn from observations of such reactions in patients on immunomodulatory therapy and in individuals with genetic immunodeficiency. Traditionally, a distinction is made between infectious and non-infectious granulomatous dermatoses. The present CME article addresses granulomatous skin diseases for which there is no evidence of a causative infectious agent. Common representatives include granuloma annulare, necrobiosis lipoidica and cutaneous sarcoidosis. Granulomatous dermatoses may be part of the clinical spectrum of various systemic disorders or may be associated therewith. Some neoplastic disorders may mimic granulomatous dermatoses histologically. Given the pathogenetic diversity involved, the clinical presentation, too, is quite varied. Overall, however, each disorder is characterized by typical clinical features. The diagnosis always requires thorough clinicopathologic correlation. Treatment is preferably based on the underlying pathogenesis and frequently involves anti-inflammatory agents. In most cases, however, there is insufficient study data. The dermal nature of these disorders frequently poses a therapeutic challenge, especially with respect to topical treatment.
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Affiliation(s)
- Andrea Schmitt
- DermatoHistologisches Labor Dr. Laaff, Freiburg, Germany
| | - Andreas Volz
- Department of Dermatology, Basel University Hospital, Basel, Switzerland
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27
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Bittar JM, Burton K, Rahnama S. Verrucous Plaques of the Buttocks, Perineum, and Umbilicus. Gastroenterology 2019; 157:1480-1482. [PMID: 31310743 DOI: 10.1053/j.gastro.2019.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/09/2019] [Indexed: 12/02/2022]
Affiliation(s)
- Julie M Bittar
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Kyle Burton
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sahand Rahnama
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
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28
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Canan O, Durdu M, Canpolat T. Çocuklarda Crohn hastalığında ekstraintestinal tanısal ipuçları nelerdir ? CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.497648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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29
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Schmitt A, Volz A. Nicht‐infektiöse granulomatöse Dermatosen. J Dtsch Dermatol Ges 2019; 17:518-535. [DOI: 10.1111/ddg.13848_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Andrea Schmitt
- DermatoHistologisches Labor Dr. Helmut Laaff Freiburg Deutschland
| | - Andreas Volz
- Dermatologische KlinikUniversitätsspital Basel Schweiz
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