Cutaneous Granulomatous Vasculitis: Presenting Feature of Crohn's Disease

Slater, D.N.; Waller, P.; Reilly, Gwendolen C.

doi:10.1177/014107688507800714

Cited by 38 publications

(19 citation statements)

References 4 publications

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“…These include an inflammatory infiltrate commonly consisting of sterile noncaseating sarcoid-type granulomas, foreign body and Langhans giant cells, epithelioid histiocytes, and plasma cells surrounded by numerous lymphomononuclear cells found within the dermis and occasionally extending into the subcutis [8–10, 12, 20, 26]. Some of these granulomas are arranged perivascularly with normal vessel walls [12, 28, 31–33], whereas others exhibit a perivasculitic pattern, as they are associated with small- and medium-vessel vasculitis [12, 20, 21, 25, 27, 28, 34, 35]. The perivascular arrangement is attributed to the theory that MCD is the result of either deposition of immune complexes or circulating antigens within the skin [7, 28].…”

Section: Histologymentioning

confidence: 99%

Metastatic Crohn’s Disease: An Approach to an Uncommon but Important Cutaneous Disorder

Aberumand

Howard

2017

BioMed Research International

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Objective. To provide physicians with a clinical approach to metastatic Crohn's disease (MCD). Main Message. Metastatic Crohn's disease, defined as skin lesions present in areas noncontiguous with the gastrointestinal tract, is the rarest cutaneous manifestation of Crohn's disease. MCD lesions vary in morphology and can arise anywhere on the skin. MCD presents equally in both sexes and across age groups. Cutaneous findings may precede, develop concurrently with, or follow gastrointestinal involvement. A detailed history and thorough physical examination including a full-skin exam may help to exclude other dermatoses, as MCD can mimic other common disorders. A biopsy is required for a definitive diagnosis. Treatment options for MCD remain underwhelming due to the lack of randomized control studies and varying responses of reported therapeutic methods. Topical, intralesional, and systemic corticosteroids, antibiotics, traditional immunosuppressants, and surgery have shown mixed results. Recently, biologics have shown promise, even with refractory cases of MCD. Conclusion. MCD is an important cutaneous manifestation of this inflammatory disorder. Although a rare entity, early recognition can provide opportunity for successful therapeutic intervention.

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Section: Histologymentioning

confidence: 99%

Metastatic Crohn’s Disease: An Approach to an Uncommon but Important Cutaneous Disorder

Aberumand

Howard

2017

BioMed Research International

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“…In 20% of cases, MCD precedes the diagnosis of intestinal Crohn disease, with skin lesions occurring 3 months to 9 years prior to gastrointestinal disease, [96,97] and it has been proposed that the timing of cutaneous and gastrointestinal disease presentation may be related to age. [98] It was first postulated that MCD lesions are caused by deposits of immune complexes in the skin, [99] which ultimately result in granulomatous reactions.…”

Section: Why Does Metastatic Crohn Disease Persist After Surgical Remmentioning

confidence: 99%

Non-Infectious Granulomatous Diseases of the Skin and their Associated Systemic Diseases

Hawryluk

Izikson

English

2010

American Journal of Clinical Dermatology

109

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Non-infectious granulomatous diseases of the skin are a broad group of distinct reactive inflammatory conditions that share important similarities. As a group, they are relatively difficult to diagnose and distinguish both clinically as well as histologically. Many of these disorders have significant associations with systemic diseases that impact the patient's overall prognosis. In this update, we offer a discussion of emerging concepts and controversies in this field, as presented through evidence-based answers to seven important clinical questions regarding palisading and epithelioid granulomata. These questions offer an opportunity to review ten non-infectious granulomatous conditions that have implications for systemic disease: granuloma annulare, annular elastolytic giant cell granuloma, necrobiosis lipoidica, methotrexate-induced accelerated rheumatoid nodulosis, necrobiotic xanthogranuloma, interstitial granulomatous dermatitis, interstitial granulomatous drug reaction, palisaded neutrophilic granulomatous dermatitis, sarcoidosis, and metastatic Crohn disease. Recent clinical, epidemiologic, and laboratory studies have shed some light on these diseases, the association of these conditions with systemic disorders, and their overall prognoses.

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“…O segundo tipo inclui manifestações cutâneas secundári-as à deficiência nutricional e reativas (imuno-relacionadas, porém sem componente granulomatoso), tais como acrodermatite enteropática (deficiência adquirida de zinco), pioderma gangrenoso, eritema nodoso, eritema multiforme, epidermólise bolhosa, amiloidose sistêmica secundária, vitiligo, pustulose palmo-plantar (19) Um segundo mecanismo sugerido, foi de reação de hipersensibilidade tipo IV, ou seja, mediada por linfócitos T, responsável pela formação dos granulomas extraintestinais e vasculite cutânea, posteriormente com necrose e ulceração da pele sobrejacente. (20)(21)(22)(23) Recentemente, novas pesquisas tentam atribuir como causas a mutação da integrina beta-2, (24) de populações de monócitos CD14+ (25) e do gene de reparo do DNA MLH-1. (26) Histologicamente, a DCM se caracteriza por granulomas cutâneos não-caseosos, com células gigantes multinucleadas de Langhans e do tipo corpo estranho, os quais se distribuem na derme superficial, derme profunda e no tecido adiposo, similares aos granulomas do trato gastrointestinal.…”

Section: Discussionunclassified

Uso de terapia biológica na doença de Crohn metastática: relato de caso e revisão da literatura

Batista

Pozzobon

Lopes³

et al. 2009

Rev bras. colo-proctol.

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RESUMO: A doença de Crohn metastática envolve a infiltração cutânea granulomatosa em locais anatomicamente separados do trato gastrointestinal, com tendência à cronicidade. É relatado caso de paciente masculino, 20 anos, há seis meses com dor e eliminação de secreção purulenta de úlceras em região perianal, inguinal direita e genital, sem melhora com o uso metronidazol e ciprofloxacina. Antecedente de proctocolectomia em 2002. Ao exame, à inspeção, evidenciava-se orifício fistuloso posterior a 2,0 cm da borda anal, úlcera de 5,0 cm na base do escroto e outra úlcera circundando a base do pênis; ao toque, ânus fibrótico e encarcerado. Realizada fistulotomia, biópsia e curetagem das úlceras genital e inguinal. O resultado histopatológico evidenciou processo inflamatório granuloso não caseoso. Em virtude da falha terapêutica dos antimicrobianos, foi optado pelo tratamento com infliximabe na dose 5 mg/kg nas semanas 0, 2 e 6, e azatioprina 2 mg/kg/dia. Ao término da fase de indução, o paciente apresentava cicatrização parcial das lesões ulceradas, ausência de secreção e alívio da dor. Atualmente em acompanhamento ambulatorial com infusões de infliximabe a cada oito semanas. Descritores INTRODUÇÃOA doença de Crohn (DC) é uma doença inflamatória intestinal de evolução crônica e recidivante, caracterizada por inflamação transmural segmentar e alterações granulomatosas, que pode envolver qualquer segmento do trato gastrointestinal. (1-9) Foi descrita em 1932 por Crohn, Ginzberg e Oppenheimer, e originalmente chamada de ileíte regional. (10) Os pacientes podem desenvolver manifestações extra-intestinais em 25 a 30% dos casos, principalmente cutâneas, as quais ocorrem em 14-44% dos casos, dependendo se a doença perineal é ou não considerada uma manifestação cutânea. (1,3,8,11) A doença de Crohn metastática (DCM) envolve a infiltração cutânea granulomatosa em locais anatomicamente separados do trato gastrointestinal, com tendência à cronicidade. (1)(2)(3)(4)(5)(6)9,(11)(12)(13)(14) Foi primeiramente descrita por Parks AG et al. em 1965. (17) Em 1970, o termo ulceração metastática foi adotado por Mountain JC para descrever as úlceras cutâneas que surgiam distantes da região perianal ou periostomal. (18) As terapias convencionais têm resultado pouco satisfatório na DCM. (2,15) A terapia biológica com

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Cutaneous Granulomatous Vasculitis: Presenting Feature of Crohn's Disease

Cited by 38 publications

References 4 publications

Metastatic Crohn’s Disease: An Approach to an Uncommon but Important Cutaneous Disorder

Metastatic Crohn’s Disease: An Approach to an Uncommon but Important Cutaneous Disorder

Non-Infectious Granulomatous Diseases of the Skin and their Associated Systemic Diseases

Uso de terapia biológica na doença de Crohn metastática: relato de caso e revisão da literatura

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