Genital edema in childhood: Harbinger of Crohn’s disease?

Reinders, Marie G H C; Kukutsch, Nicole A.

doi:10.1016/j.jaad.2010.02.037

Cited by 12 publications

(10 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Cellulitis is a demonstration of cause and effect whereby reduced lymph flow inhibits the ability of the immune system to properly respond to insult resulting in a continuous inflammatory reaction. Interestingly, some rare or underreported forms of IBD often resemble many aspects of cellulitis microscopically and, are associated with bouts of localized edema, particularly in the pelvic and genital areas (52, 59). Recent work in an ileitis model of intestinal inflammation has shown that the intrinsic pumping mechanisms of lymphatics are disrupted by inflammation.…”

Section: Discussionmentioning

confidence: 99%

Colonic Insult Impairs Lymph Flow, Increases Cellular Content of the Lymph, Alters Local Lymphatic Microenvironment, and Leads to Sustained Inflammation in the Rat Ileum

Cromer

Wang

Zawieja

et al. 2015

Inflammatory Bowel Diseases

View full text Add to dashboard Cite

Background Lymphatic dysfunction has been linked to inflammation since the 1930’s. Lymphatic function in the gut and mesentery is grossly underexplored in models of IBD despite the use of lymphatic occlusion in early models of IBD. Activation of the innate and adaptive immune system is a hallmark of TNBS-induced inflammation and is linked to disruption of the intrinsic lymph pump. Recent identification of crosstalk between lymphatic vessel resident immune cells and regulation of lymphatic vessel contractility underscore the importance of the timing of lymphatic dysfunction during tissue inflammation in response to TNBS. Methods To evaluate lymphatic function in TNBS induced inflammation, lymph was collected and flow measured from mesenteric lymphatics. Cellularity and cytokine profile of the lymph was also measured. Histopathology was performed to determine severity of injury and immunofluorescent staining of the mesentery was done to evaluate changes in the population of immune cells that reside near and on gastro-intestinal collecting lymphatics. Results Lymph transport fell 24hrs after TNBS administration and began recovering at 72hrs. Significant reduction of lymph flow preceded significant increase in histopathological score and occurred simultaneously with increased MPO activity. These changes were preceded by increased MHCII+ cells surrounding mesenteric lymphatics leading to an altered lymphatic environment that would favor dysfunction. Conclusions Alterations in environmental factors that effect lymphatic function occur before the development of gross GI inflammation. Reduced lymphatic function in TNBS-mediated inflammation is likely an early factor in the development of injury and that recovery of function is associated with resolution of inflammation.

show abstract

Section: Discussionmentioning

confidence: 99%

Colonic Insult Impairs Lymph Flow, Increases Cellular Content of the Lymph, Alters Local Lymphatic Microenvironment, and Leads to Sustained Inflammation in the Rat Ileum

Cromer

Wang

Zawieja

et al. 2015

Inflammatory Bowel Diseases

View full text Add to dashboard Cite

show abstract

“…In severe cases, clinicians can consider surgical debridement or hyperbaric oxygen . For patients with granulomatous lymphangitis with genital edema, circumcision is an appropriate treatment option if clinically appopriate . For patients with ulcerative lesions, treatment with repeated curettage and oral zinc sulfate has been reported .…”

Section: Treatmentmentioning

confidence: 99%

“…18 Genital edema can also be a sign of granulomatous lymphangitis, which is considered to be an atypical and incomplete of CD. 19,20 Granulomatous lymphangitis has been identified on histology from the genitals in several cases of MCD, showing development of granulomas similar to CD. 20 Three cases (4.8%) in our review were found to have granulomatous lymphangitis on histologic examination.…”

Section: (Continues)mentioning

confidence: 99%

“…19,20 Granulomatous lymphangitis has been identified on histology from the genitals in several cases of MCD, showing development of granulomas similar to CD. 20 Three cases (4.8%) in our review were found to have granulomatous lymphangitis on histologic examination. 5,21 Although not considered MCD because of contiguity with the gastrointestinal tract, 25%-30% of patients have perianal lesions upon clinical examination before development of gastrointestinal complaints.…”

Section: (Continues)mentioning

confidence: 99%

“…11 For patients with granulomatous lymphangitis with genital edema, circumcision is an appropriate treatment option if clinically appopriate. 20 For patients with ulcerative lesions, treatment with repeated curettage and oral zinc sulfate has been reported. 2,12 Other treatments include sulfasalazine ointment, tetracycline hydrochloride ointment, intralesional Kenalog, mesalamine, and oral sulfasalazine.…”

Section: (Continues)mentioning

confidence: 99%

See 2 more Smart Citations

Cutaneous manifestations of metastatic Crohn's disease

Schneider

Foster²,

Patel

et al. 2018

Pediatric Dermatology

View full text Add to dashboard Cite

Metastatic Crohn's disease is a rare cutaneous complication of primary Crohn's disease. It is a granulomatous inflammatory process, similar to the pathogenic mechanism of Crohn's disease, that occurs in sites discontiguous from the gastrointestinal tract. Metastatic Crohn's disease can precede the development of Crohn's disease by months to years, and children are more likely to present with metastatic Crohn's disease in the absence of gastrointestinal symptoms. Given that approximately 30% of individuals with Crohn's disease present in childhood, early recognition of extraintestinal manifestations of Crohn's disease such as metastatic Crohn's disease can aid in timely diagnosis and management of bowel disease. We present data from two pediatric cases of metastatic Crohn's disease recently seen at our institution in addition to the 61 reported cases of pediatric metastatic Crohn's disease in the literature. This review article will focus on the epidemiology, pathogenesis, clinical features, and histology of and treatment options for pediatric metastatic Crohn's disease.

show abstract