Case for diagnosis. Metastatic Crohn's disease

Gontijo, João Renato Vianna; Leidenz, Franciele Antonieta Bianchi; Sousa, Maria Silvia Laborne Alves de

doi:10.1590/abd1806-4841.20165731

Cited by 3 publications

(8 citation statements)

References 9 publications

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“…Se ha sugerido que la reacción granulomatosa a distancia puede ser efecto del depósito de inmunocomplejos del tracto gastrointestinal en la piel. Otros autores apoyan la teoría de la reactividad cruzada entre antígenos de estos dos orígenes 5,6 . En enfermos con este padecimiento, en particular en aquéllos con manifestaciones extraintestinales, pueden encontrarse complejos inmunitarios inespecíficos circulantes en sangre 6 .…”

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“…Otros autores apoyan la teoría de la reactividad cruzada entre antígenos de estos dos orígenes 5,6 . En enfermos con este padecimiento, en particular en aquéllos con manifestaciones extraintestinales, pueden encontrarse complejos inmunitarios inespecíficos circulantes en sangre 6 .…”

Section: Discussionunclassified

“…No hay correlación establecida entre la actividad de las lesiones cutáneas y el deterioro gastrointestinal. En la mayor parte de los casos, la ECC afecta a pacientes con EC en curso; sin embargo, puede precederla en el 20% de los pacientes, lo que hace aún más difícil el diagnóstico 3,6 .…”

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“…La histología describe típicamente granulomas no caseificantes, con células gigantes de Langhans, histiocitos epitelioides, linfocitos, plasmocitos y eosinófilos, que son similares a los hallazgos gastrointestinales 6 . Éstos se pueden encontrar en la dermis papilar, la dermis inferior y también el tejido celular subcutáneo.…”

Section: Discussionunclassified

“…Dado que las lesiones cutáneas son clínicamente inespecíficas, el diagnóstico se basa en los hallazgos dermopatológicos y la exclusión de otras enfermedades e infecciones granulomatosas 6 .…”

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Enfermedad de Crohn cutánea en un adulto con enfermedad intestinal estable en tratamiento con adalimumab

Miranda¹,

Elías²,

Herrero³

et al. 2021

MCUT

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afección en la piel. Caso clínico: Varón de 43 años de edad que presentaba una úlcera en el glúteo izquierdo, asintomática, de cuatro meses de evolución. Tenía como antecedente enfermedad de Crohn ileal de fenotipo estenosante, tratado con adalimumab desde dos años antes, sin actividad al momento de la consulta. La histopatología reveló granulomas confluentes sin caseosis central. Las técnicas de Ziehl Neelsen y PAS resultaron negativas. No hubo desarrollo de bacterias, micobacterias u hongos en los cultivos. Con el antecedente de enfermedad inflamatoria intestinal, la clínica y los estudios complementarios se confirmó el diagnóstico de enfermedad de Crohn cutánea. Conclusión: Se comunica un caso infrecuente de enfermedad de Crohn cutánea, debido a su aparición en un paciente con enfermedad de Crohn intestinal estable tratado con adalimumab. Además, debido a la presentación clínica inicial en forma de pústula y su posterior evolución a úlcera, es importante distinguirlo del pioderma gangrenoso.

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Enfermedad de Crohn cutánea en un adulto con enfermedad intestinal estable en tratamiento con adalimumab

Miranda¹,

Elías²,

Herrero³

et al. 2021

MCUT

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Fistulising skin metastases in Crohn’s disease: a case report and review of the literature

Elger,

Loibl,

Buechler

et al. 2024

J Med Case Reports

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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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Metastatic crohn’s disease in a child: rare extraintestinal manifestation

Yablokova,

Khavkin,

Erokhina

et al. 2024

APPS

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Extraintestinal manifestations occur in every second child with Crohn’s disease, can affect any organ system, and determine the type of therapy and prognosis of the disease. The skin is the most frequent “target organ” of all extraintestinal manifestations, the spectrum of skin lesions is extremely clinically and pathogenically heterogeneous. Metastatic Crohn’s disease (MBC) is a rare extraintestinal manifestation of the disease, approaches to the diagnosis and management of which are not standardized in either adults or children. The most frequent description of MBC in the literature is skin damage, although interstitial lung damage, bone and muscle damage, and ENT organs, could be destructive. MCD lesions vary in morphology and can arise anywhere on the skin, rarely undergo reverse development, require special approaches to therapy. The primary diagnosis of such elements is extremely difficult, often delated, biopsy is required for a definitive diagnosis - the detection of epithelioid granuloma and its elements outside the gastrointestinal tract. Therapeutic approaches to MCD are not standardized now, they are carried out according to the protocols of CD management, and the effect of the use of oral steroids, a-TNFa drugs is shown. A case of metastatic Crohn’s disease in a 16-year-old teenager with an unusual localization - the nasal septum is described. The destructive nature of the lesion with the formation of perforation of the nasal septum determined the difficult path of differential diagnosis with Wegener’s granulomatosis. Morphological examination of the biopsy of the nasal mucosa revealed epithelioid cells of sarcoid-like granuloma. Systemic glucocorticosteroids use (GCS) led to epithelialization of the nasal septum defect and a decrease in the activity of CD in the intestine mucosa.

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Case for diagnosis. Metastatic Crohn's disease

Cited by 3 publications

References 9 publications

Enfermedad de Crohn cutánea en un adulto con enfermedad intestinal estable en tratamiento con adalimumab

Enfermedad de Crohn cutánea en un adulto con enfermedad intestinal estable en tratamiento con adalimumab

Fistulising skin metastases in Crohn’s disease: a case report and review of the literature

Metastatic crohn’s disease in a child: rare extraintestinal manifestation

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