Effects of Perianal Involvement on Clinical Outcomes in Crohn's Disease over 10 Years

BACKGROUND/AIMS: There was the assumption that Crohn's disease (CD) patients with perianal lesions might have different clinical courses compared to those without. However, quantifiable data comparing the long-term outcomes between the two groups are scarce. METHODS: We retrospectively reviewed 221 consecutive patients newly diagnosed with CD and registered at the IBD clinic of Severance Hospital, in Seoul, Korea, between January 1990 and October 2005. We compared patients with perianal CD (PCD) and non-perianal CD (NPCD) in terms of clinical outcomes over 10 years. RESULTS: PCD progressed more frequently from inflammatory to complicated behavior than NPCD. Moreover, corticosteroids were prescribed in 102 patients with PCD and only 57 with NPCD (82.9% vs 58.2%, p < 0.001), immunosuppressants in 89 and 42 (72.4% vs 42.9%, p < 0.001), and anti-tumor necrosis factor α (TNF-α) in 37 and 12 (30.1% vs 12.2%, p=0.002). Cumulative hospitalization rates were 82.1% in PCD and 72.4% in NPCD (p=0.086), and surgical intervention rates were 39.8% and 51.0%, respectively (p=0.097). CONCLUSIONS: Patients with PCD were more likely than those with NPCD to be administered corticosteroids, immunosuppressants, and anti-TNF-α. However, there is no significant difference in the cumulative rates of surgical interventions or hospitalizations.

Langerhans cell histiocytosis: An uncommon presentation, successfully treated by thalidomide.

Langerhans cell histiocytosis (LCH) is a rare disease and generally affects children under 15 years of age. Adult onset form and cutaneous features at presentation are uncommon. There are some options for treatment of the skin lesions of LCH such as topical and intralesional corticosteroid, nitrogen mustard, etc., which are not completely curative. Herein, we report a case of perianal LCH in a 20-year-old man with one-year history of recalcitrant well-demarcated, erythematous, and ulcerated plaque surrounding the anal orifice, with pain and difficulty in defecation that was successfully treated with thalidomide.

Paracoccidioidomicosis con afectación mucocutánea / Paracoccidioidomycosis with mucocutaneous involvement

La paracoccidioidomicosis es una micosis sistémica endémica de zonas rurales de América Latina. Se comunica el caso de un paciente varón de 51 años, trabajador en la cosecha de algodón en Chaco, que presentó una lesión perianal ulcerada y otra lesión sobreelevada e indurada en el paladar. El diagnóstico de paracoccidioidomicosis se estableció sobre la base de los hallazgos histopatológicos, la obtención de cultivos con aislamiento de Paracoccidioides brasiliensis y el resultado de la reacción de inmunodifusión. Se realizó tratamiento con itraconazol, con evolución favorable.

Paracoccidioidomycosis is a systemic mycosis, endemic in rural areas of Latin America. Wereport the case of a 51 year-old man, cotton-harvest worker in the province of Chaco. Hepresented a perianal ulcer as well as a raised and infiltraded palate lesion. The diagnosisof paracoccidioidomycosis was established upon histopathological findings, the isolationof Paracoccidioides brasiliensis on cultures, and the results from immunodiffusion reaction.Itraconazol was given with favorable outcome.

Doença de Crohn em recém-nascido / Crohn's disease in newborn baby: report of case

A Doença de Crohn ocorre, principalmente, em adultos jovens. Sua incidência entre membros da mesma família aproxima-se de 10 por cento. Atualmente, os sintomas aparecem cada vez mais precocemente em crianças e adolescentes. No caso que relatamos, um paciente aos três dias de vida iniciou quadro de extensa lesão perianal, desenvolvendo, ulteriormente, outras complicações da Doença de Crohn. Esta criança apresentava, em sua história familiar, dois irmãos com a mesma doença, porém que não sobreviveram às complicações abdominais pós-operatórias. Chamou-nos a atenção a precocidade e a intensidade com que tais manifestações se apresentaram, implicando em sérias conseqüências ao paciente, já na primeira semana de vida.

Crohn's Disease occurs, mainly, in young adults. The incidence of this disease in other members of the same family is nearly 10 percent. Nowadays the symptoms start precociously in children and teenagers. In the present case, the perianal disease was detected in three days old baby who developed different complications throughout his life. The child had two siblings with the same problems, but none of them survived after post-operative abdominal complications.