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Cutaneous manifestations of Crohn's disease, its spectrum, and its
pathogenesis: intracellular consensus bacterial 16S rRNA is
associated with the gastrointestinal but not the cutaneous
manifestations of Crohn's disease.Hum
Pathol. 2003 Nov;34(11):1185-92.
The classic
pathology of skin disease discontinuous from the inflamed
gastrointestinal (GI) tract in patients with Crohn's disease (CD)
includes pyoderma gangrenosum (PG), erythema nodosum (EN), and
so-called metastatic Crohn's disease. The purpose of this study was
two-fold: First, we explored the full spectrum of cutaneous lesions
associated with Crohn's disease, and second, we sought to explore a
potential molecular basis of the skin lesions in patients with CD.
In this regard, we analyzed skin and GI tract biopsies from affected
patients for the consensus bacterial SrRNA to determine whether
direct bacterial infection was associated with either condition.
Formalin-fixed, paraffin-embedded sections were studied and
correlated to clinical presentation and histories from 33 patients
with CD. Consensus bacterial RNA sequences were analyzed using an RT
in situ PCR assay on both skin biopsy and GI biopsy material. The GI
tract material included biopsies from 3 patients who had skin
lesions and from 7 patients in whom there were no known skin
manifestations. There were 8 cases of neutrophilic dominant dermal
infiltrates, including pyoderma gangrenosum, 6 cases of granuloma
annulare/necrobiosis lipoidica-like lesions, 5 cases of sterile
neutrophilic folliculitis, 5 cases of panniculitis, 4 cases of
vasculitis, 2 cases of psoriasis, 2 cases of lichenoid and
granulomatous inflammation, and 1 case of classic metastatic CD.
Intracellular bacterial 16S rRNA was detected in 8 of 10 tissues of
active CD in the GI tract, of which 3 of the cases tested were from
patients who also developed skin lesions at some point in their
clinical course; in contrast, none of the skin biopsies had
detectable bacterial RNA. The dermatopathological manifestations of
CD discontiguous from the involved GI tract mucosa have in common a
vascular injury syndrome, typically with a prominent extravascular
neutrophilic and/or histiocytic dermal infiltrate. In addition, this
study, the first to document in situ intracellular consensus
bacterial SrRNA in the GI tract in CD, suggests that hematogenous
dissemination of viable microbes is not associated with the
cutaneous manifestations of this disease. Bacteria do, however,
appear to play a role in bowel lesions of patients with CD.
Cutaneous metastatic Crohn's disease.Rev
Med Interne. 2003 Mar;24(3):198-201.
INTRODUCTION:
Cutaneous metastatic Crohn's disease is a granulomatous inflammation
of the skin that is noncontiguous to the gastrointestinal tract.
CASE REPORT: A 42-year-old man with Crohn's disease is admitted for
antibiotic resistant erysipela-like dermo-hypodermitis. The presence
of granulomatous lesions on skin biopsy, the absence of any
infectious agent identified despite extensive investigations and the
dramatic improvement observed with corticosteroid eventually lead to
the diagnosis of cutaneous metastatic Crohn's disease. CONCLUSION:
During Crohn's disease, biopsy should be considered for every
undiagnosed skin lesion as the characteristics of cutaneous
metastatic Crohn's disease are not specific. The presence of a non
caseous granulomatous dermal infiltration suggests the diagnosis and
should make consider the initiation of corticosteroid and the
discontinuation of others inappropriate therapeutics (i.e. surgical
treatment, antibiotics).
Metastatic Crohn's disease. A rare cutaneous manifestation.J
Clin Gastroenterol. 1993 Dec;17(4):300-3.
Cutaneous
extraintestinal manifestations of Crohn's disease are common.
Lesions contiguous with the gastrointestinal tract, such as perianal,
peristomal, and perifistular inflammation are characterized by the
histologic demonstration of granulomas. Rarely a cutaneous
granulomatous lesion occurs that is noncontiguous with the
gastrointestinal tract and is separated from it by normal skin. We
report axillary "metastatic" Crohn's disease that appeared with
exacerbation of the inflammatory bowel disease and responded well to
steroid therapy.
Metastatic
Crohn's disease. Report of 3 cases with special reference to
histopathologic findings.Arch
Dermatol. 1996 Aug;132(8):928-32
BACKGROUND:
Metastatic Crohn's disease is a rare, often unrecognized cutaneous
disorder lacking definite histopathologic criteria. The purpose of
this study was to document clinicopathologic and immunologic
findings in 3 patients with metastatic Crohn's disease. The
histopathologic findings are evaluated in correlation to those
reported in the literature in an attempt to better define the
histopathologic features. OBSERVATIONS: None of the patients showed
signs of depressed cell-mediated immune response as evaluated with
skin tests and T-cell subtyping of blood samples. One of the
patients had antineutrophil cytoplasmic antibodies. Polymerase chain
reaction, a highly efficient method of amplifying low levels of
specific DNA sequences, did not show mycobacterial DNA in the
samples studied. Granulomas of the sarcoid type with numerous
foreign body and Langhans giant cells were the dominating features.
In accordance with previous results, we found vascular involvement
in 2 cases, manifested as granulomatous perivasculitis in both. We
also found necrobiotic areas in all 3 cases. CONCLUSIONS: We propose
that both necrobiosis and granulomatous perivasculitis be added to
the histopathologic characteristics of metastatic Crohn's disease.
Patients may even have a positive antineutrophil cytoplasmic
antibody test result.
Metastatic Crohn's
disease.J
Am Acad Dermatol. 1984 Jan;10(1):33-8
Cutaneous
granuloma formation distant from the gastrointestinal tract in
patients with Crohn's disease of the bowel has been called
metastatic Crohn's disease. We report two patients with this entity,
including the first to present with an erysipelas-like eruption of
the face. A review of the world's literature reveals that all
patients with metastatic Crohn's disease have had gastrointestinal
disease involving the colon or rectum. Clinical features of the nine
previously reported cases are reviewed.
Cutaneous
manifestations of Crohn's disease.J
Am Acad Dermatol. 1981 Dec;5(6):689-95.
Crohn's disease
is a chronic inflammatory bowel disease which may have distinctive
mucocutaneous manifestations. Included in this group are perianal,
peristomal, and perifistular ulceration, as well as granulomatous
cutaneous inflammation separate from gastrointestinal tract openings
(metastatic Crohn's disease). In the oral cavity, both ulcerations
and granulomatous nodules may occur. Malabsorption of nutrients may
lead to several changes, including an acrodermatitis enteropathica-like
syndrome secondary to zinc deficiency. Patients with Crohn's disease
may also have pyoderma gangrenosum, erythema nodosum, cutaneous
vasculitis, and other less specific changes.
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