Remission of refractory metastatic Crohn's disease achieved with dapsone (original) (raw)

CROHN'S DISEASE AND EXTRA INTESTINAL GRANULOMATOUS LESIONS

F.C. and A.L. share last authorship Crohn's disease (CD) is an inflammatory bowel disease with a multifactorial etiology. Clinical features include mucosal erosion, diarrhea, weight loss and other complications such as formation of granuloma. In CD, granuloma is a non-neoplastic epithelioid lesion, formed by a compact aggregate of histiocytes with the absence of a central necrosis, however, the correlation among CD and the formation of granulomas is unknown. Many cases of granulomas in the extracellular site, related to CD, have been reported in the literature. These granulomas, at times, represented the only visible manifestation of the pathology. Extra intestinal granulomas have been found on ovaries, lungs, male genitalia, female genitalia, orofacial regions and skin. From the data in the literature it could be hypothesized that there is a cross-reaction of the immune system with similar antigenic epitopes belonging to different sites. This hypothesis, if checked, can place CD not only among inflammatory bowel disease but also among inflammatory diseases with systemic involvement. Crohn's disease (CD) is an inflammatory bowel disease (IBD) characterized by a chronic inflammatory process. The etiology of CD is multifactorial and involves a combination of genetic and environmental factors. The set of these factors generates a condition known as dysbiosis that, by altering the eubiotic equilibrium of the intestinal flora, leads to a continuous and massive activation of the lymphoid tissue associated with the intestine (GALT) (1, 2), and the establishment of a chronic inflammatory state, characterized by the release of various chemical mediators of inflammation, such as heat shock proteins (HSP) (2, 3). CD involves the entire gastrointestinal tract from the mouth to the anus and manifests itself with clinical features including mucosal erosion, mucus-bloody ulcers, diarrhea, weight loss, and abdominal pain (1-3). Among the complications of the disease, the most important are predisposition to dysplasia and colorectal cancer (due to the generation by TNF-alpha of a metaplasic alteration of the genetic material of the enterocyte and/or colonocyte), visceral stenosis and onset of granulomas (4). This article focuses on the general

Cutaneous Crohn's disease: ‘metastatic Crohn's is a misnomer’

Journal of the European Academy of Dermatology and Venereology, 1999

Cost effectiveness in testing for sensitization in cases of leg ulcers To the Editor: In the literature the frequency of sensitization in subjects with leg ulcers is reported to range from 14 to 84% [14]. We did patch tests on 34 consecutive subjects (13 males and 21 females, mean age 71 years, range 42-87), with leg ulcers (24

Metastatic Crohn's disease despite infliximab therapy

Anais brasileiros de dermatologia, 2017

Metastatic Crohn's disease is a rare extraintestinal manifestation of Crohn's disease. It is characterized by polymorphic skin lesions formed by non-caseating granulomas located on anatomical sites distant from the gastrointestinal tract. We report a rare case of metastatic Crohn's disease, simultaneously displaying multiple clinically heterogeneous cutaneous lesions, in a patient with previously diagnosed Crohn's disease in remission due to anti-TNF-α use. This case highlights the need for high clinical suspicion and early biopsy in the setting of a patient with Crohn's disease and persistent skin lesions, even under biologic therapy. Furthermore, it reinforces the need of monitoring of the serum level of infliximab, increasing the dose in case it is low or undetectable.

Crohn's Disease – Disease for Immunologists, Proctologists, Gastroenterologists or Rheumatologists?

The Eurasia Proceedings of Health, Environment and Life Sciences

Crohn's Disease (CD) most commonly affects the terminal portion of the small intestine and the large intestine. CD can also affect any other part of the gastrointestinal tract, from mouth to anus. Inflammation of the intestines is usually not continuous, areas inflammation (foci of inflamed bowel) interspersed with normal areas intestines (segmental lesion). Depending on the severity of the inflammation the inner layer of the intestinal wall (mucosa) may turn red (erythematous) and swollen (edematous) with ulcers of different sizes and shapes (aphthae’s, superficial, deep, longitudinal), and the mucous membrane can have the appearance of a "cobblestone pavement". These lesions extend throughout the thickness intestinal wall and can lead to complications such as stenosis of the intestinal lumen and / or germination in other organs (penetration), resulting in abscesses (infiltration of intestinal contents into the abdominal cavity) or fistulas (channels that connect the ...

A Single Disease with Double Complications: Crohn's Disease

Respiratory Case Reports, 2015

Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. Extra intestinal manifestations of CD may involve almost every organ system. Thrombosis and thromboembolic events are more frequent than in the normal population; additionally, drugs that are used to control disease activity have many side effects. One of the main problems associated with these drugs are immunosuppression, which may lead to many infections and malignancy. We present a case of 62-year-old woman, who has been diagnosed with Crohn's disease. She was admitted with complaints of shortness of breath. The patient was diagnosed with pulmonary thromboembolism through computerized tomography during admission. Low molecular weight heparin was initiated. During treatment, a skin discoloration was noticed in her lower extremities, and after thorough evaluation, the patient was diagnosed Kaposi's sarcoma by a skin biopsy. Although thromboembolic events are expected during inflammatory diseases, Kaposi's sarcoma development is not. We identified the immunosuppression as the most probable cause of Kaposi's sarcoma development.

Chronic Granulomatous Disease Mimicking Colonic Crohn's Disease Successfully Treated with Infliximab

ACG case reports journal, 2017

Chronic granulomatous disease (CGD) is a genetically induced disease caused by mutations in one of the components of the NADPH-oxidase in phagocytes, characterized by life-threatening bacterial and fungal infections and granuloma formation. Treatment includes prevention of infectious complications and immunomodulation. However, a standard strategy is not yet defined. The authors report an X-linked CGD female carrier who presented during adulthood with diarrhea and colorectal ulcers, with high impairment of quality of life. Induction with infliximab 5 mg/kg (weeks 0, 2, and 6) with infectious prophylaxis was initiated. She continued infliximab 5 mg/kg every 8 weeks with complete symptomatic response at 15 months.

A difficult case of Crohn's disease?

Case Reports, 2011

BACKGROUND Chronic granulomatous disease (CGD) is a rare genetically heterogenous primary immunodefi ciency disorder. About 20% of patients are affected by granulomatous colitis mimicking Crohn's disease. Although the infl ammatory process in the gut in CGD may be different from that in Crohn's, the clinical, endoscopic, radiological and histological features may be indistinguishable. Management of this granulomatous colitis can be a challenge in view of the high risk of sepsis on introducing immunosuppressant drugs.