1/64. Crohn's disease mimicking sarcoidosis in bronchoalveolar lavage.Granulomatous disorders like sarcoidosis or Crohn's disease are commonly associated with extrapulmonary or extraintestinal manifestations which occasionally may represent the only symptoms. We describe a 28-year-old female patient suffering from atypical erythema nodosum and arthritis. Although the chest x-ray was unremarkable bronchoalveolar lavage revealed lymphocytic alveolitis with an elevated CD4/CD8 ratio of 8 and 11.4 at repeated examinations suggesting a diagnosis of sarcoidosis. Further diagnostic workup included endoscopy of the bowel. The macroscopic aspect and histology of the terminal small bowel and colon ascendens indicated Crohn's disease. The patient recovered on steroids and sulfasalazine. Six months later she developed a perianal abscess for which she needed surgery supporting the diagnosis of Crohn's disease. This is the first case of a significantly (>6) elevated CD4/CD8 ratio in Crohn's disease previously regarded as highly specific for sarcoidosis.- - - - - - - - - - ranking = 1keywords = erythema nodosum, nodosum, erythema (Clic here for more details about this article) |
2/64. Sweet's syndrome in a patient with acute Crohn's colitis and longstanding ankylosing spondylitis.Acute neutrophilic dermatosis, also referred to as Sweet's syndrome according to the first description in 1964, occurs not only as an isolated phenomenon but also in the context of neoplastic and inflammatory diseases, occasionally including arthritides. Recently Sweet's syndrome has been reported in a small number of patients with chronic inflammatory bowel disease, mostly in advanced stages of the disease. Here, we describe the sudden outbreak of acute neutrophilic dermatosis in coincidence with the onset of severe Crohn's disease (CD) in a patient with long-standing ankylosing spondylitis (AS). This condition has not been described before and therefore Sweet's syndrome should be added to the spectrum of skin manifestations the rheumatologist has to think about in the context of the spondylarthropathies (SpA). Furthermore, this case report is of interest because the skin lesions of Sweet's syndrome are somewhat similar to psoriasis, which is a rather frequent feature of the spondylarthropathies. This article intends to clarify the clinical and histological differentiation between Sweet's syndrome, psoriatic skin lesions and erythema nodosum for the rheumatologist and stresses that these conditions must each be treated in a completely different manner.- - - - - - - - - - ranking = 1keywords = erythema nodosum, nodosum, erythema (Clic here for more details about this article) |
3/64. Sweet's syndrome in a patient with Crohn's disease.Crohn's disease is rarely associated with Sweet's syndrome. We report a 32-year old woman who presented with diarrhea, fever and disseminated erythematous plaques on the arms and the trunk. After colonoscopy with biopsies, Crohn's disease was diagnosed. Skin biopsy showed a dense infiltration of neutrophilic polymorphonuclear leukocytes, establishing also the diagnosis of Sweet's syndrome. Crohn's disease is one of several systemic diseases that may underlie Sweet's syndrome. Treatment with methylprednisolone resulted in a rapid improvement of both gastro-intestinal symptoms and skin lesions.- - - - - - - - - - ranking = 0.013260596266343keywords = erythema (Clic here for more details about this article) |
4/64. Genital cutaneous crohn disease: two cases with unusual clinical and histopathologic features in young men.Cutaneous crohn disease, sometimes called metastatic crohn disease or crohn disease with cutaneous involvement, is a rare complication of crohn disease in which granulomatous lesions involve skin separated from gastrointestinal lesions by normal tissue. We report two cases of cutaneous crohn disease presenting in young males with erythematous, nontender swelling of the scrotum. One of the young males presented erythematous, nontender swelling of the penis as well. In one case, cutaneous crohn disease represented the primary presentation. The original biopsy in this case showed unusual areas of degeneration of dermal connective tissue forming cystic cavities. The diagnostic biopsies in both cases showed sarcoidal granulomas with an associated superficial and deep perivascular mixed infiltrate including eosinophils. On endoscopy, both patients showed lesions of active crohn disease in the colon. Because changes that would suggest cutaneous crohn disease may not be present on the initial biopsy, unusual presentations and negative cultures may warrant a second biopsy. A high index of suspicion and open communication with the clinician are essential to diagnose this disease.- - - - - - - - - - ranking = 0.026521192532686keywords = erythema (Clic here for more details about this article) |
5/64. Metastatic Crohn's disease: case report of an unusual variant and review of the literature.PURPOSE: Metastatic Crohn's disease is a rare complication of Crohn's disease that has been infrequently reported in the literature. We report a case where submammary, inguinal, and perineal disease was observed in a patient many years after a proctocolectomy. The proliferative and polypoid morphology of the cutaneous lesions has not been previously described. In addition, this case describes severe cutaneous metastatic Crohn's disease in the absence of active gastrointestinal disease, which to our knowledge has not been reported in the literature. RESULTS: A 55-year-old female with a 25-year history of Crohn's disease was investigated and treated over a 12-month period for metastatic Crohn's disease involving the submammary, inguinal, and perineal areas. These proliferative lesions with erythema and ulceration were histologically consistent with metastatic Crohn's disease. Gram and Ziehl Nielsen stains revealed no pathogenic organisms. The use of topical solutions, antibiotics, immunosuppression, and surgery failed to produce any significant benefit. A review of 42 cases of metastatic Crohn's disease in the literature is reported. CONCLUSION: Cutaneous metastatic Crohn's disease has an extremely variable macroscopic appearance and may be a source of considerable morbidity. It can be present without other significant symptomatology, although it more commonly parallels gastrointestinal disease activity. There are no trials to guide current treatment, which is mainly based on anecdotal reporting.- - - - - - - - - - ranking = 0.013260596266343keywords = erythema (Clic here for more details about this article) |
6/64. Acute Crohn's colitis with lobular panniculitis--metastatic Crohn's?One of the common lesions in Crohn's colitis is erythema nodosum, a septal panniculitis that may appear before diagnosis or in conjunction with flare up. We report a case of Crohn's colitis where the presenting sign was neutrophilic lobular panniculitis with few granulomas. The possibility that this case represents a forme fruste of metastatic Crohn's is suggested. As skin biopsies are not usually performed by gastroenterologists in erythema nodosum-like skin lesions in Crohn's patients it may well be that the incidence of lobular panniculitis is higher than reported in the literature.- - - - - - - - - - ranking = 2keywords = erythema nodosum, nodosum, erythema (Clic here for more details about this article) |
7/64. Fatal evolution of systemic lupus erythematosus associated with Crohn's disease.The authors describe the case of a young Brazilian woman who was treated of ileocolonic Crohn's disease sparing rectum, as confirmed by colonoscopy and histopathological examination. After a 4-year course of sulfasalazine treatment, she presented with skin facial lesions in vespertilio, fever, arthralgias and high titers of anti-ANA and LE cells. A sulfasalazine-induced lupus syndrome was diagnosed, because after sulfasalazine withdrawal and a short course of prednisone, the clinical symptoms disappeared and the laboratory tests returned to normal. Mesalazine 3 g/day was started and the patient remained well for the next 3 years, when she was again admitted with fever, weakness, arthralgias, diplopy, strabismus and hypoaesthesia in both hands and feet, microhematuria, haematic casts, hypocomplementemia and high titers of autoimmune antibodies. A diagnosis of associated systemic lupus erythematosus was made. Although a pulsotherapy with methylprednisolone was started, no improvement was noticed. A cyclophosphamide trial was tried and again no positive results occurred. The patient evolved to severe clinical manifestations of general vasculitis affecting the central and peripheral nervous system and lungs, having a fatal evolution after 2 weeks. Although uncommon, the association of both disease may occur, and the authors call attention to this possibility, making a brief review of literature.- - - - - - - - - - ranking = 0.066302981331716keywords = erythema (Clic here for more details about this article) |
8/64. Rapid response of severe refractory metastatic Crohn's disease to infliximab.A case is described of a middle-aged female who developed an aggressive form of biopsy-proven metastatic Crohn's disease involving the inguinal, perineal and submammary areas. Her condition had been unresponsive to topical and systemic corticosteroids, antibiotics, immunosuppressives, and repeated surgical debridement. Administration of infliximab resulted in a rapid clinical response with subjective improvements in pain and general well-being, and an objective decline in exudate, erythema and size of the lesions. Infliximab may be a suitable therapeutic option in patients with metastatic Crohn's disease.- - - - - - - - - - ranking = 0.013260596266343keywords = erythema (Clic here for more details about this article) |
9/64. Treatment of vitamin d deficiency due to Crohn's disease with tanning bed ultraviolet B radiation.In Crohn's disease, severe skeletal demineralization, secondary hyperparathyroidism, and muscle weakness can occur. This may be caused by impaired vitamin D absorption, resulting from extensive intestinal disease and resection of duodenum and jejunum, where vitamin D is absorbed. We report a 57-year-old woman with a long history of Crohn's disease and short-bowel syndrome who had only 2 feet of small intestine remaining after 3 bowel resections. She was taking a daily multivitamin containing 400 IU of vitamin D(3) and was dependent on total parenteral nutrition that contained 200 IU of vitamin D and calcium (18 mEq in a 1-L bag infused over 8 hours daily) for a period of 36 months. Despite the above replacement, she complained of bone pain and muscle weakness, and she continued to be vitamin D-deficient with a 25(OH)D level <20 ng/mL. She was then exposed to ultraviolet B (UVB) radiation in a tanning bed wearing a 1-piece bathing suit for 10 minutes, 3 times a week for 6 months at the General Clinical research Center, boston University Medical Center. She tolerated the irradiation well without evidence of erythema. After 4 weeks, her serum 25(OH)D level increased by 357% from 7 to 32 ng/mL, parathyroid hormone level decreased by 52% from 92 to 44 pg/mL, and the serum calcium level increased from 7.8 to 8.5 mg/dL. After 6 months of UVB treatment, her serum 25(OH)D level was maintained in the normal range and was free of muscle weakness, and bone and muscle pain.- - - - - - - - - - ranking = 0.013260596266343keywords = erythema (Clic here for more details about this article) |
10/64. A case of Behcet's disease accompanied by colitis with longitudinal ulcers and granuloma.A 37-year-old female presenting with oral and genital ulcers and erythema nodosum on both arms was diagnosed as having Behcet's disease. The symptoms resolved spontaneously. However, she was admitted to our hospital (Keio University Hospital) several months later because of fever, aphthous ulcers of the oral cavity, lower abdominal pain and frequent diarrhea. A colonoscopic examination revealed multiple ulcers including longitudinal ulcers in the ascending and transverse colon, and histological examination of biopsied specimens demonstrated non-caseating epithelioid granuloma. Treatment with prednisolone and 5-aminosalicylic acid was started, and the patient responded well clinically. One month later, a repeated colonoscopy confirmed that the lesions including longitudinal ulcers had disappeared. In this report, we describe our experience of this rare case of Behcet's disease concomitant with colonic longitudinal ulcers and epithelioid granuloma, and discuss the difficulties in making a differential diagnosis, primarily with regard to Crohn's disease.- - - - - - - - - - ranking = 1keywords = erythema nodosum, nodosum, erythema (Clic here for more details about this article) |
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