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

Abstract

Bowel-associated dermatosis-arthritis syndrome (BADAS) is a rare and recurrent neutrophilic dermatosis condition. Due to the rarity of this syndrome and the difficulty of the disease recognition and management, there was no clear reported incidence rate of this syndrome. 20% of patients after ileojejunal bypass surgery for morbid obesity were reported, by Jorizzo et al., to have BADAS. The underlying etiology of BADAS is not fully understood; therefore, the diagnosis of this condition is difficult and the approach for the management as well. Herein, we report a case of BADAS with unusual musculoskeletal presentation.

Pustules, arthritis, and fever in a patient with Crohn's disease

“…During the inpatient stay, several painful, indurated, erythematous nodules developed on both ankles (Figure 1a Bowel-associated dermatosis-arthritis syndrome is a rare neutrophilic dermatosis that was first described in patients after bypass surgery for obesity, although its association with IBD and other gastrointestinal conditions has been previously reported. 1 Fever, flu-like symptoms, polyarthritis, and inflammatory skin involvement are the hallmarks of BADAS, as presented by our patient. 2 Skin lesions typically present as recurrent erythematous papules and vesiculopustules on the upper portion of the trunk and the extremities.…”

“…2 Skin lesions typically present as recurrent erythematous papules and vesiculopustules on the upper portion of the trunk and the extremities. 1 Less frequent manifestations include plaques, nodules, and abscesses that may resemble other neutrophilic dermatoses, such as Sweet's syndrome, pyoderma gangrenosum, or hidradenitis suppurativa. 2 In most cases, patients develop a symmetrical, nonerosive peripheral polyarthritis, which may also be associated with tenosynovitis.…”

“…It has been suggested that bacterial overgrowth and intestinal inflammation would cause an aberrant immune response with inflammation of the skin and synovium because of the deposition of immune complexes. 1 The diagnosis of BADAS can be challenging because of the lack of defined diagnostic criteria and the fact that BADAS can mimic a number of different dermatoses. 5 Histologically, BADAS is characterized by a marked neutrophilic infiltrate that can extend from the epidermis into the adipose tissue, involving lobules and septa.…”

“…Hence, clinicopathological correlation in a patient with a gastrointestinal disorder is fundamental for the diagnosis of BADAS. 1 There is no established algorithm in the treatment of BADAS.…”

“…Treatment options include antibiotics, systemic corticosteroids, dapsone, and sulfapyridines. 1,2 Also, many authors highlight the importance of treating the underlying condition. The interleukin-12/23-inhibitor ustekinumab has also shown effectiveness in one case report.…”