The spectrum of inflammatory skin disease following jejuno-ileal bypass for morbid obesity

Kennedy, Cameron

doi:10.1111/j.1365-2133.1981.tb00774.x

Cited by 55 publications

(39 citation statements)

References 30 publications

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“…Nonsteroidal anti-inflammatory drugs have controlled the symptoms of arthritis in some patients, whereas tetracyclines, metronidazole, sulfapyridine, and dapsone have been effective in other reports. 4,8,10 With rare exception, reanastomosis to reestablish bowel continuity has eliminated the syndrome. 9,10, [15][16][17] Although originally described after jejuno-iliac bypass, BADAS occurs more commonly after a jejuno-colic anastomosis 18 and has also been described in association with bilio-pancreatic diversion or bilio-intestinal bypass for morbid obesity, 19,20 Crohn disease, ileoanal pouch anastomosis, 21,22 ulcerative colitis, appendicitis, 23 diverticulitis, 11 and after Billroth II gastrectomy.…”

Section: Discussionmentioning

confidence: 98%

Spondyloarthropathy After Ampullary Carcinoma Resection

Bhangle¹,

Kramer²,

Rosenstein³

2009

JCR: Journal of Clinical Rheumatology

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The development of bowel-bypass syndrome complicating the Whipple procedure for biliary tract carcinoma is described here for the first time. A 56-year-old HLA-B27 + man, treated with excision of adenocarcinoma of the ampulla of Vater, developed an undifferentiated spondyloarthropathy, initially unresponsive to nonsteroidal anti-inflammatory drugs and doxycycline, but eventually controlled with sulfasalazine and tapered corticosteroids. This condition represents another example of a rheumatic syndrome occurring after disruption of gastrointestinal tract continuity and likely development of small bowel bacterial overgrowth.

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Section: Discussionmentioning

confidence: 98%

Spondyloarthropathy After Ampullary Carcinoma Resection

Bhangle¹,

Kramer²,

Rosenstein³

2009

JCR: Journal of Clinical Rheumatology

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“…Erythema nodosum-like lesions [8], pustular erythematous Sweet-like rashes and papular eruptions with IgG and C3 deposition [9] have also been described to occur after surgical weight loss. The spectrum of inflammatory manifestations following gastric bypass surgery is large [10]; nevertheless, major consideration has to be given to several more skin manifestations that are linked either to nutritional deficiencies or the surgical stress itself.…”

Section: Discussionmentioning

confidence: 99%

Dermatological Complications after Bariatric Surgery: Report of Two Cases and Review of the Literature

Zouridaki¹,

Papafragkaki²,

Papafragkakis³

et al. 2014

Dermatology

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Bariatric surgery aims at weight reduction of severely obese patients. The Roux-en-Y technique is one of the most common bariatric procedures and is occasionally accompanied by nutrient insufficiencies and metabolic changes. According to the literature, skin architecture and immunity change after bariatric surgery and may lead to inflammation and increased susceptibility to pathogens. Additionally, vitamin and mineral deficiencies frequently develop in these patients and affect the skin's defense mechanisms, possibly contributing to dermatological complications. Knowledge and recognition of skin changes after bariatric surgery make an important asset for the dermatologist and help in the proper treatment of these patients. We report 2 cases of infectious skin lesions where vitamin and trace element deficiencies have possibly contributed to their persistence and resistance to traditional treatments.

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“…This is characterized by an influenza-like illness in 10-20% of patients, with malaise, fever, non-erosive polyarthralgia or arthritis and the development of skin lesions [1,2]. It has been proposed that bacterial overgrowth in a blind loop of bowel results in the formation of immune complexes, which enter the circulation and produce the clinical features [3][4][5]. The characteristic skin lesions appear in crops as small erythematous macules (less than 1 cm diameter) progressing through an indurated urticarial stage to vesiculo-pustular lesions over a 24 -48 hour period, healing without scarring over about 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

Bowel-associated dermatosis-arthritis syndrome: A case report

2009

Journal of the American Academy of Dermatology

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We report a rare case of Bowel Associated Dermatosis -Arthritis Syndrome in a young patient with complex Crohn's disease who presented with fever, arthritis, rash and worsening of diarrhea with abdominal pain, who promptly responded to a short course of steroids. Case PresentationA 23 year old white male with a 4 year history of Crohn's disease presented with an acute two day history of malaise, fever, abdominal pain, vomiting and stomal diarrhoea. He complained of joint pains affecting the shoulders, elbows, wrists, metacarpophalangeals, knees and ankles. There was also a rash on the elbows, ankles and feet, which began as erythematous macules and evolved to vesico-pustular lesions followed by crusting. There was no history of sexual exposure or any intercurrent infection. He was on no regular medication, but had discontinued Pentasa 4 months earlier.One month earlier he had undergone a laparotomy to excise a complex ileo-cutaneous fistula with blind tracts, and two weeks earlier a defunctioning ileostomy had been created in view of persistent abdominal pain. The cutaneous fistula had been present for a year, but was associated with a terminal ileal stricture and ileo-rectal fistula of at least 2 years duration. His bowel disease had been resistant to immunosuppressive drugs including azathioprine, corticosteroiods and three infusions of Infliximab a year earlier. There had been no extra-intestinal manifestations.On admission to the hospital, he was thin, afebrile with a resting tachycardia of 125/minute. The rest of the cardiorespiratory examination was normal. The abdomen was minimally tender around the ileostomy without guarding or rebound tenderness. Examination of the skin revealed some pustules and crusts around the elbows, ankles and feet (Fig 1 and 2). The buttocks were spared. There were clinical signs of synovitis of the wrists, proximal interphalangeal and metacarpophalangeal joints, and also both ankles.Results of the laboratory tests showed a haemoglobin of 13.1 gm/dl, white blood count 15.8 × 10 9 /L, platelets 585 × 10 9 /L, C-reactive protein 37.7 mg/L and erythrocyte sedimentation rate 69 mm/hr. Urea and electrolytes, complement, urine analysis and microscopy were normal. Rheumatoid factor, antinuclear and antineutrophil cytoplasmic antibodies, cryoglobulins and Hepatitis B and C serology were negative. Transthoracic echocardiogram showed no signs of endocarditis, and multiple blood cultures were sterile. A skin biopsy from the ankle revealed a perivascular lymphohistiocytic infiltrate with prominent neutrophils and associated fibrinoid necrosis of vessels consistent with 'leukocytoclastic' vasculitis.He was commenced on 60 mg prednisolone per day leading to prompt and complete resolution of all features. The dose of prednisolone was rapidly tapered over the course

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The spectrum of inflammatory skin disease following jejuno-ileal bypass for morbid obesity

Cited by 55 publications

References 30 publications

Spondyloarthropathy After Ampullary Carcinoma Resection

Spondyloarthropathy After Ampullary Carcinoma Resection

Dermatological Complications after Bariatric Surgery: Report of Two Cases and Review of the Literature

Bowel-associated dermatosis-arthritis syndrome: A case report

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