Metastatic Crohn’s Disease: An Approach to an Uncommon but Important Cutaneous Disorder

Objective. To provide physicians with a clinical approach to metastatic Crohn’s disease (MCD).Main Message. Metastatic Crohn’s disease, defined as skin lesions present in areas noncontiguous with the gastrointestinal tract, is the rarest cutaneous manifestation of Crohn’s disease. MCD lesions vary in morphology and can arise anywhere on the skin. MCD presents equally in both sexes and across age groups. Cutaneous findings may precede, develop concurrently with, or follow gastrointestinal involvement. A detailed history and thorough physical examination including a full-skin exam may help to exclude other dermatoses, as MCD can mimic other common disorders. A biopsy is required for a definitive diagnosis. Treatment options for MCD remain underwhelming due to the lack of randomized control studies and varying responses of reported therapeutic methods. Topical, intralesional, and systemic corticosteroids, antibiotics, traditional immunosuppressants, and surgery have shown mixed results. Recently, biologics have shown promise, even with refractory cases of MCD.Conclusion. MCD is an important cutaneous manifestation of this inflammatory disorder. Although a rare entity, early recognition can provide opportunity for successful therapeutic intervention.

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2′-5′-oligoadenylate synthetase 2 (OAS2) is differentially expressed in the blood of patients with Crohn’s disease.

10.31219/osf.io/mw2cy ◽

2020 ◽

Author(s):

Shahan Mamoor

Keyword(s):

Gene Expression ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Treatment Options ◽

Gastrointestinal Disorder ◽

The United States ◽

Differentially Expressed ◽

Inflammatory Disorder ◽

Oligoadenylate Synthetase ◽

Public Datasets

Crohn’s disease, a complex genetic inflammatory disorder of the gastrointestinal tract (1), has a prevalence of 214 per 100,000 in the United States (2), one of the highest in the world. Understanding of the interaction between genetic susceptibility loci (1) and triggers from the environment (3, 4) is growing but there are still no curative treatments for patients with Crohn’s disease (CD); some patients will fail even the most advanced treatment options (5). Though CD is considered a gastrointestinal disorder, hematologic disturbances are found in patients with Crohn’s disease and anemia is the most common extra-intestinal manifestation of Crohn’s disease (6). To understand the most significant gene expression changes in the hematologic system of patients with Crohn’s disease, we mined published and public datasets (7, 8) containing transcriptome data from the monocyte-derived macrophage (MDM) and multiplexed gene expression data from the regulatory T-cells (Treg) of patients with Crohn’s disease. We found that interferon-inducible nucleic acid sensor 2′-5′-oligoadenylate synthetase 2 (OAS2) (9) was among the most differentially expressed genes in both MDM and Treg from patients with Crohn’s disease. OAS2 expression was significantly lower in MDM and Treg from patients with Crohn’s disease compared to healthy controls. These data reveal compromised expression of an antiviral dsRNA sensor in the blood of patients with Crohn’s disease.

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Pediatric Metastatic Crohn's Disease

Journal of Coloproctology ◽

10.1055/s-0041-1724066 ◽

2021 ◽

Vol 41 (01) ◽

pp. 079-082

Author(s):

Amanda Trindade de Oliveira ◽

Raissa Albuquerque Calais de Oliveira ◽

Matheus Matta Machado Duque Estrada Meyer ◽

Ilson Geraldo da Silva ◽

Matheus Duarte Massahud

Keyword(s):

Crohn’S Disease ◽

Gastrointestinal Tract ◽

Crohn's Disease ◽

Skin Lesions ◽

Rapid Progression ◽

Colorectal Surgeon ◽

Transmural Inflammation ◽

Gastrointestinal Complaints ◽

Intravenous Steroids ◽

Metastatic Crohn's Disease

AbstractCrohn's disease (CD) is a chronic, relapsing, idiopathic condition, characterized by granulomatous, transmural inflammation of the gastrointestinal tract, which can affect its entire length, from mouth to anus. Metastatic Crohn's disease (MCD) is a rare form of skin involvement and is defined by skin lesions without contiguity with the gastrointestinal tract. A 9-year-old patient presented with gastrointestinal complaints and gross skin lesions in the vulva and perianal region. The diagnosis of Crohn's disease was made when the patient was 11 years old, after being evaluated by the colorectal surgeon. Treatment was started with a “top-down” approach, with a sustained response for four years. Afterwards, there was a relapse of the skin disease in previously normal areas, without overt symptoms. Treatment consisted of steroids and local infiltration of infliximab, without improvement. A year later, there was a rapid progression of the skin lesions, and the drug changed to adalimumab, also without response and worsening of the skin lesions. The patient was admitted to the hospital and intravenous steroids were initiated, along with surgical debridement of the lesions. After some improvement, ustekinumab was initiated with satisfactory response. Pediatric MCD has an important impact on the patient's quality of life, with influences on growth and social development.

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Metastatic Crohn's Disease of the Ear

International Journal of Otolaryngology ◽

10.1155/2009/871567 ◽

2009 ◽

Vol 2009 ◽

pp. 1-3 ◽

Cited By ~ 6

Author(s):

J. H. Chuah ◽

D. S. Kim ◽

C. Allen ◽

L. Hollis

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Rare Case ◽

Antibody Therapy ◽

Rare Condition ◽

Skin Lesions ◽

Cutaneous Lesions ◽

Disease Treatment ◽

Lower Trunk ◽

Metastatic Crohn's Disease

Objective. We reported a very rare case of metastatic Crohn's disease involving the retro-auricular region.Method. A case report and a review of literature concerning metastatic Crohn's disease.Results. Metastatic Crohn's disease is an uncommon extraintestinal cutaneous manifestation of Crohn's disease and a very rare case involving the retro-auricular region is reported here. Given the limited existing literature little is known about this condition. The skin lesions appear to have a predilection for the lower trunk and genitalia regions. There is no clear association with the severity of Crohn's disease and in some cases, the cutaneous lesions predate the onset of gastrointestinal Crohn's disease. Treatment with immune-modulating medications together with the antitumour necrosis factor monoclonal antibody therapy appears to offer the best chance of remission.Conclusion. By reporting this interesting and rare condition we also hope to highlight the importance of considering underlying chronic systemic disorders, such as Crohn's disease, when presented with skin lesions resistant to simple local treatments.

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Successful treatment of therapy-resistant metastatic Crohn's disease with infliximab

British Journal of Dermatology ◽

10.1111/j.1365-2133.2004.05958.x ◽

2004 ◽

Vol 150 (5) ◽

pp. 1045-1046 ◽

Cited By ~ 17

Author(s):

A. Rispo

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Successful Treatment ◽

Metastatic Crohn's Disease

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Pulmonary Crohn's Disease in Down Syndrome: A Link or Linkage Problem

Case Reports in Gastroenterology ◽

10.1159/000445975 ◽

2016 ◽

Vol 10 (2) ◽

pp. 206-211

Author(s):

Danyal Thaver ◽

Mirza Beg

Keyword(s):

Down Syndrome ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Pediatric Population ◽

Pulmonary Nodules ◽

Pulmonary Involvement ◽

Lung Nodules ◽

Inflammatory Disorder ◽

Ct Guided ◽

History Of

Crohn’s disease (CD) is an autoimmune inflammatory disorder that primarily affects the gastrointestinal tract. It may have pulmonary involvement, which has been rarely reported in pediatric patients. Down syndrome (DS) has been associated with increased frequency of autoimmune diseases. However, associations between CD and DS have been rarely reported. We present the case of a 5-year-old girl with known DS and a history of chronic intermittent abdominal pain who presented with persistent pneumonia. Her workup included a chest computed tomography (CT) scan that showed multiple noncalcified pulmonary nodules. An extensive infectious workup was done that was negative. CT-guided needle biopsy of the lung nodules showed necrotizing granulomas. This raised concern for primary CD with extraintestinal pulmonary manifestation. An esophagogastroduodenoscopy and colonoscopy were performed, and colon biopsies showed scattered epithelioid granulomas. Based on this information, there was consensus that her lung nodules were secondary to CD. She was started on standard therapy for CD, and her abdominal and respiratory symptoms gradually improved. However, she continues to have mild residual lung calcification and fibrosis. To our knowledge, this is the first reported case of pulmonary CD in a child with DS. The natural history of pulmonary CD in the pediatric population is not very well studied. Furthermore, since DS has been well known to be associated with increased frequency of malignancies and autoimmune conditions due to immune dysregulation, it is difficult to predict the severity and possible complications in this patient.

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Metastatic Crohn's disease of the umbilicus.

BMJ ◽

10.1136/bmj.283.6296.887 ◽

1981 ◽

Vol 283 (6296) ◽

pp. 887-887 ◽

Cited By ~ 9

Author(s):

R K Phillips ◽

G Glazer

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Metastatic Crohn's Disease

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Metastatic Crohn’s disease despite infliximab therapy

Anais Brasileiros de Dermatologia ◽

10.1590/abd1806-4841.20175713 ◽

2017 ◽

Vol 92 (5 suppl 1) ◽

pp. 104-106 ◽

Cited By ~ 1

Author(s):

Sara Campos ◽

Inês Coutinho ◽

José Carlos Cardoso ◽

Francisco Portela

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Infliximab Therapy ◽

Metastatic Crohn's Disease

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Junctional Ectopic Tachycardia: Recognition and Modern Management Strategies

Critical Care Nurse ◽

10.4037/ccn2020793 ◽

2020 ◽

Vol 40 (1) ◽

pp. 46-55

Author(s):

Kirsti G. Catton ◽

Jennifer K. Peterson

Keyword(s):

Risk Factors ◽

Congenital Heart ◽

Heart Surgery ◽

Early Recognition ◽

Treatment Options ◽

Age Groups ◽

Atrioventricular Node ◽

Congenital Heart Surgery ◽

Junctional Ectopic Tachycardia ◽

Perioperative Morbidity

Junctional ectopic tachycardia is a common dysrhythmia after congenital heart surgery that is associated with increased perioperative morbidity and mortality. Risk factors for development of junctional ectopic tachycardia include young age (neonatal and infant age groups); hypomagnesemia; higher-complexity surgical procedure, especially near the atrioventricular node or His bundle; and use of exogenous catecholamines such as dopamine and epinephrine. Critical care nurses play a vital role in early recognition of dysrhythmias after congenital heart surgery, assessment of hemodynamics affecting cardiac output, and monitoring the effects of antiarrhythmic therapy. This article reviews the underlying mechanisms of junctional ectopic tachycardia, incidence and risk factors, and treatment options. Currently, amiodarone is the pharmacological treatment of choice, with dexmedetomidine increasingly used because of its anti-arrhythmic properties and sedative effect.

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