Leukocytoclastic Vasculitis as an Onset Symptom of Crohn’s Disease

Abstract

We report the case of an octagenerian who presented with leukocytoclastic vasculitis as the first symptom of Crohn’s disease. The patient was admitted with skin rash on the lower extremities and ankles and episodes of bloody diarrhea. Skin and colon biopsies revealed acute leukocytoclastic vasculitis and moderate Crohn’s disease, respectively. The patient was treated with intravenous corticosteroids in conjunction with antibiotics and per os mesalazine. Symptoms resolved rapidly within 5 days, and the patient was still asymptomatic on follow-up 3 months later.

Cutaneous manifestations in inflammatory bowel disease: a single institutional study of non‐neoplastic biopsies over 13 years

“…The hypercoagulable state associated with IBD is thought to be related, in part, to the overlap between the coagulation cascade and the complement cascade . The association of leukocytoclastic vasculitis (an immune complex disease) with Crohn disease in particular is not well established and has only rarely been documented in case reports . Our data support an underrecognized and underreported association here.…”

Cutaneous Vasculitis, Interstitial Pneumonia with Crazy-Paving Appearance, and Positive pANCA in a Patient with Severe Crohn’s Disease

“…However, the link between the cutaneous lesions and CD in this patient cannot be excluded. Consistent with the observations reported by Tsiamoulos et al [ 3 ] and Zlatanic et al [ 4 ], the skin lesions related to CD likely have a good response to the immunosuppressant therapy. And, in our case, the aggressive immunosuppressive treatment for cutaneous vasculitis and interstitial lung disease may in fact retard the subsequent development of full-blown CD.…”

“…Mader et al [ 2 ] searched in the MEDLINE database and only one case presented with cutaneous leukocytoclastic vasculitis as the initial manifestation of CD 3 months before the bowel disease was reported. Similarly, Tsiamoulos et al [ 3 ] reported a case of an octogenarian with cutaneous vasculitis in the skin as the first symptom of CD 2 months before the bowel disease. The typical pathology patterns of these CD-related cutaneous lesions include vasculitis, extravascular neutrophilia, and granulomatous inflammation [ 1 ].…”

Cutaneous Manifestations in Patients With Inflammatory Bowel Diseases

“…Cutaneous small-vessel vasculitis is the most common type of cutaneous vasculitis and affects mainly the skin postcapillary venules. 146 The cutaneous picture is typically polymorphous 147 and ranges from palpable purpura to urticarial and necrotic ulcerative lesions predominantly involving the legs (Fig. 10), whereas its extracutaneous, particularly renal, manifestations are relatively uncommon.…”