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Darlington K, Googe P, Vedak P, Jain A, Long MD, Barnes EL, Herfarth HH. Lower Extremity Palpable Purpura in a Patient with Quiescent Inflammatory Bowel Disease. Dig Dis Sci 2023:10.1007/s10620-023-07934-0. [PMID: 37024743 PMCID: PMC10079141 DOI: 10.1007/s10620-023-07934-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Kimberly Darlington
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Campus Box #7080, Chapel Hill, NC, 27599-7080, USA
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul Googe
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Priyanka Vedak
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Animesh Jain
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Campus Box #7080, Chapel Hill, NC, 27599-7080, USA
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Campus Box #7080, Chapel Hill, NC, 27599-7080, USA
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Campus Box #7080, Chapel Hill, NC, 27599-7080, USA.
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Hans H Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Campus Box #7080, Chapel Hill, NC, 27599-7080, USA
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Friedman BJ, Dasgeb B, Lee JB. Cutaneous Crohn's disease with superimposed psoriasis: A unique case with overlapping histology. J Cutan Pathol 2017; 44:588-590. [PMID: 28294378 DOI: 10.1111/cup.12928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 01/15/2023]
Abstract
Crohn's disease (CD) is an idiopathic, chronic inflammatory disorder of the gastrointestinal tract. We recently encountered a unique case in which a patient with longstanding CD presented with skin lesions with histopathologic features of both psoriasis and granulomatous inflammation suggestive of cutaneous CD. To our knowledge, this has not been described concomitantly in the same patient, in the same lesions. Review of the literature suggests that the intersection of these 2 histopathological reaction patterns may not be pure coincidence. Clinical-pathologic correlation of this case will be discussed, along with a review of the potential mechanisms of this unique disease presentation.
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Affiliation(s)
- Ben J Friedman
- Department of Dermatology & Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Bahar Dasgeb
- Department of Dermatology & Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason B Lee
- Department of Dermatology & Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
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3
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Abstract
Awareness of the extraintestinal manifestations of Crohn disease is increasing in dermatology and gastroenterology, with enhanced identification of entities that range from granulomatous diseases recapitulating the underlying inflammatory bowel disease to reactive conditions and associated dermatoses. In this review, the underlying etiopathology of Crohn disease is discussed, and how this mirrors certain skin manifestations that present in a subset of patients is explored. The array of extraintestinal manifestations that do not share a similar pathology, but which are often seen in association with inflammatory bowel disease, is also discussed. Treatment and pathogenetic mechanisms, where available, are discussed.
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Affiliation(s)
- Joshua W Hagen
- Department of Dermatology, University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 5th Floor, Pittsburgh, PA 15213, USA
| | - Jason M Swoger
- Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop street, C-Wing, Mezzanine, Pittsburgh, PA 15213, USA
| | - Lisa M Grandinetti
- Department of Dermatology, University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 5th Floor, Pittsburgh, PA 15213, USA.
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4
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Sy A, Khalidi N, Dehghan N, Barra L, Carette S, Cuthbertson D, Hoffman GS, Koening CL, Langford CA, McAlear C, Moreland L, Monach PA, Seo P, Specks U, Sreih A, Ytterberg SR, Van Assche G, Merkel PA, Pagnoux C. Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature. Semin Arthritis Rheum 2016; 45:475-82. [PMID: 26315859 PMCID: PMC4982464 DOI: 10.1016/j.semarthrit.2015.07.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/10/2015] [Accepted: 07/22/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Published small case series suggest that inflammatory bowel disease [IBD; Crohn's disease (CD) or ulcerative colitis (UC)] and vasculitis co-occur more frequently than would be expected by chance. OBJECTIVES To describe this association by an analysis of a large cohort of carefully studied patients and through a systematic literature review. METHODS Patients with both IBD and vasculitis enrolled in the Vasculitis Clinical Research Consortium (VCRC) Longitudinal Studies, followed in Canadian Vasculitis research network (CanVasc) centers and/or in the University of Toronto's IBD clinic were included in this case series. A systematic literature review of patients with IBD and vasculitis involved a PubMed search through February 2014. The main characteristics of patients with Takayasu arteritis (TAK) and IBD were compared to those in patients with TAK without IBD followed in the VCRC. RESULTS The study identified 32 patients with IBD and vasculitis: 13 with large-vessel vasculitis [LVV; 12 with TAK, 1 with giant cell arteritis (GCA); 8 with CD, 5 with UC]; 8 with ANCA-associated vasculitis [AAV; 6 granulomatosis with polyangiitis (GPA), 2 with eosinophilic granulomatosis with polyangiitis (EGPA)]; 5 with isolated cutaneous vasculitis; and 6 with other vasculitides. Patients with LVV and AAV were mostly female (18/21). The diagnosis of IBD preceded that of vasculitis in 12/13 patients with LVV and 8/8 patients with AAV. The review of the literature identified 306 patients with IBD and vasculitis: 144 with LVV (133 TAK; 87 with IBD preceding LVV), 19 with AAV [14 GPA, 1 EGPA, 4 microscopic polyangiitis (MPA)], 66 with isolated cutaneous vasculitis, and 77 with other vasculitides. Patients with IBD and TAK were younger and had more frequent headaches, constitutional symptoms, or gastrointestinal symptoms compared to those patients in the VCRC who had TAK without IBD. CONCLUSIONS These findings highlight the risk of vasculitis, especially TAK, in patients with IBD (both CD and UC).
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Affiliation(s)
- Alice Sy
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, The Joseph and Wolf Lebovic Building, 60 Murray St, Ste 2-220, Toronto, Ontario, Canada M5T 3L9
| | - Nader Khalidi
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | - Natasha Dehghan
- Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lillian Barra
- Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, The Joseph and Wolf Lebovic Building, 60 Murray St, Ste 2-220, Toronto, Ontario, Canada M5T 3L9
| | | | - Gary S Hoffman
- Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Carol A Langford
- Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH
| | - Carol McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - Larry Moreland
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | - Paul A Monach
- The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, MA; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA
| | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Antoine Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN
| | - Gert Van Assche
- Division of Gastroenterology, University of Toronto-Inflammatory Bowel Disease Clinic, Toronto, Ontario, Canada
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - Christian Pagnoux
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, The Joseph and Wolf Lebovic Building, 60 Murray St, Ste 2-220, Toronto, Ontario, Canada M5T 3L9.
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Ratzinger G, Zelger BG, Carlson JA, Burgdorf W, Zelger B. Das Vaskulitis-Rad - ein algorithmischer Ansatz für kutane Vaskulitiden. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.20_12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gudrun Ratzinger
- Universitätsklinik für Dermatologie und Venerologie; Medizinische Universität Innsbruck; Innsbruck Österreich
| | | | - J. Andrew Carlson
- Department of Pathology; Divisions of Dermatology and Dermatopathology, Albany Medical College; Albany New York USA
| | - Walter Burgdorf
- Abteilung für Dermatologie und Allergologie; Ludwig-Maximilians-Universität München; München Deutschland
| | - Bernhard Zelger
- Universitätsklinik für Dermatologie und Venerologie; Medizinische Universität Innsbruck; Innsbruck Österreich
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Ratzinger G, Zelger BG, Carlson JA, Burgdorf W, Zelger B. Vasculitic wheel - an algorithmic approach to cutaneous vasculitides. J Dtsch Dermatol Ges 2015; 13:1092-117. [DOI: 10.1111/ddg.12859] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Gudrun Ratzinger
- Department of Dermatology and Venereology; Medical University Innsbruck; Innsbruck Austria
| | | | - J. Andrew Carlson
- Department of Pathology; Divisions of Dermatology and Dermatopathology; Albany Medical College; Albany New York
| | - Walter Burgdorf
- Department of Dermatology and Allergology; Ludwig Maximilian University; Munich Germany
| | - Bernhard Zelger
- Department of Dermatology and Venereology; Medical University Innsbruck; Innsbruck Austria
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Kurtzman DJB, Jones T, Lian F, Peng LS. Metastatic Crohn's disease: a review and approach to therapy. J Am Acad Dermatol 2014; 71:804-13. [PMID: 24888520 DOI: 10.1016/j.jaad.2014.04.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/31/2014] [Accepted: 04/01/2014] [Indexed: 12/18/2022]
Abstract
Metastatic Crohn's disease (CD) is a rare cutaneous manifestation of CD that was first described nearly 50 years ago. Many subsequent reports have defined its most common clinical and histopathologic features. The pathogenesis underlying metastatic CD is unknown but various hypotheses exist. An established standard therapy is lacking. Owing to its rarity and nonspecific clinical presentation along with the diversity of inflammatory skin disorders that often complicate CD, the diagnosis of metastatic CD may be overlooked. This report highlights the salient features of this disorder to facilitate recognition and management of this rare dermatosis.
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Affiliation(s)
- Drew J B Kurtzman
- Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona.
| | - Trevor Jones
- Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona
| | - Fangru Lian
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona
| | - Lisan S Peng
- Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona
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