Bowel-Associated Dermatosis-Arthritis Syndrome in an Adolescent With Short Bowel Syndrome

Abstract

Bowel-associated dermatosis-arthritis syndrome (BADAS) is a neutrophilic dermatosis, characterized by the occurrence of arthritis and skin lesions related to bowel disease with or without bowel bypass. We report an unusual case of BADAS in a 15-year-old white male with congenital aganglionosis of the colon and hypoganglionosis of the small intestine and multiple bowel surgeries in childhood complicated by short bowel syndrome. He presented with recurrent peripheral polyarthritis, tenosynovitis, and painful erythematous subcutaneous nodules located on the dorsolateral regions of the legs and on the dorsa of the feet. Histological examination disclosed a neutrophilic dermatosis confirming the diagnosis of BADAS. Although an uncommon disease, especially at pediatric age, it is important to evoke the diagnosis of BADAS in children and adolescents with bowel disease, because treatment options and prognosis are distinct from other rheumatologic conditions.

Enthesitis in Bowel-Associated Dermatosis-Arthritis Syndrome in an Ulcerative Colitis Patient

“…Currently, little is known about the pathogenesis of BADAS. It has been suggested that intestinal inflammation and bacterial overgrowth may lead to abnormal activation of the immune system, which in turn leads to the deposition of immune complexes on the skin and synovium [ 3 ]. The histological appearance of BADAS is not characteristic.…”

Bowel-associated dermatosis-arthritis syndrome (BADAS) in a pediatric patient

“… 2 BADAS has also been reported as the presenting prodrome of Crohn's disease in an adolescent, however to our knowledge, this case illustrates one of the youngest pediatric patients with this condition in the English-language literature. 6 , 7 …”

The Bowel-Associated Arthritis–Dermatosis Syndrome (BADAS): A Systematic Review

“…After removing duplicates ( n = 232) and articles deemed not relevant through title and abstract screening ( n = 328), 56 articles were evaluated in full text. Among them, 51 articles (comprising 42 individual case reports and 9 case series) fulfilled the eligibility criteria [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ,…”

“…The following supporting information can be downloaded at: , Table S1: All included publications presenting cases of patients with bowel-associated dermatosis-arthritis syndrome; Table S2: Cases excluded. References [ 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ,…”