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The clinical data of a child with very early onset inflammatory bowel disease (VEO-IBD) treated in the digestive department of Guangzhou Women's and children's Medical Center in October 2018 were analyzed retrospectively. The patient was hospitalized because of "shortness of breath and abdominal distension" after birth. The gastrointestinal manifestations were diarrhea, mucus bloody stool, feeding intolerance and weight loss; the extraintestinal manifestations were liver function damage and joint damage. Endoscopic examination considered VEO-IBD. The patients were treated with infliximab and enteral nutrition. When the clinical symptoms were relieved and the gastrointestinal mucosa healed, the enteral nutrition regimen was adjusted. At present, she returned to daily diet, and the weight and height reached the level of normal children. VEO-IBD patients can be combined with a variety of extraintestinal manifestations, clinicians need to identify the coexistence of these diseases, effective follow-up.
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Resumen Las vasculitis leucocitoclásticas se definen como el daño e inflamación de las paredes vasculares, son aquellas vasculitis de pequeños vasos que anatomopatológicamente presentan leucocitoclasia y puede observarse como una manifestación extraintestinal de la enfermedad inflamatoria intestinal. En la colitis ulcerativa se presentan en menor frecuencia, por inmunocomplejos generados en la mucosa intestinal debido a la exposición del tejido linfoide submucoso a antígenos fecales; podrían precipitarse en las paredes de los pequeños vasos. Se pueden asociar con Clostridium difficile, que es un bacilo grampositivo esporulado, anaerobio estricto, que se encuentra normalmente en el medio ambiente y produce colitis, que se manifiesta como un cuadro diarreico presentado después de la ingesta de antibióticos y altera la flora bacteriana común de este órgano. El caso se trata de un paciente 36 años de edad con cuadro de diarreas líquidas con moco y escaso sangrado; se realizó un estudio endoscópico y anatomopatológico en el que se observó colitis ulcerativa con coproparasitario positivo para antígeno de C. difficile, y en su hospitalización presentó lesiones dérmicas petequiales y necróticas en el cuarto dedo de la mano izquierda, que en la biopsia dio como resultado vasculitis de pequeños vasos. En este artículo se revisan de forma práctica los aspectos relacionados con la fisiopatología, histología, tratamiento y diagnósticos de la manifestación extraintestinal dermatológica rara, como la vasculitis leucocitoclástica en pacientes con colitis ulcerativas asociadas con Clostridium.
Abstract Leukocytoclastic vasculitis is defined as the damage and inflammation of the vascular walls. The term refers to vasculitis of the small vessels that anatomopathologically present leukocytoclasia and it can be seen as an extra-intestinal manifestation of inflammatory bowel disease. In ulcerative colitis, it occurs less frequently due to immune complexes produced in the intestinal mucosa by exposure of the submucosal lymphoid tissue to fecal antigens, which could precipitate in the walls of the small vessels. This condition can be associated with Clostridium difficile, which is a gram-positive, sporulated, strict anaerobic bacillus, normally found in the environment. It causes colitis that manifests as a diarrheal disease following the ingestion of antibiotics that alter the common bacterial flora of this organ. This is the case report of a 36-year-old patient with liquid diarrhea with mucus and scarce bleeding. Endoscopic and anatomopathological studies were performed, finding ulcerative colitis with positive coproparasite for Clostridium difficile antigen. The patient was hospitalized, and during his stay, he presented with petechiae and necrotic skin lesions on the fourth finger of the left hand. Skin biopsy showed small vessel vasculitis. This article is a practical review of the pathophysiology, histology, treatment, and diagnosis of a rare dermatologic extraintestinal manifestation, namely, leukocytoclastic vasculitis, in patients with C. difficile-associated ulcerative colitis.
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Humans , Male , Adult , Vasculitis , Inflammatory Bowel Diseases , Colitis, Ulcerative , Clostridioides difficile , Skin , Therapeutics , Diarrhea , Fingers , HistologyABSTRACT
Some of the patients with inflammatory bowel disease (IBD) can develop symptoms originated from extragastrointestinal organs and systems, and are called extraintestinal manifestations (EIMs). EIMs may be associated with IBD-related injuries or being drug-induced. These manifestations may occur before, after or simultaneously with the diagnosis of IBD. EIMs may detrimentally impact patient's functional status and quality of life. This article reviewed the pancreatic manifestations in patients with IBD and its underlying pathophysiology. EIMs may complicate the course of IBD. The clinicians must pay real attention to EIMs for facilitating the early diagnosis and treatment.
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Inflammatory bowel disease (IBD) is a chronic and recurrent inflammation of gastrointestinal tract caused by disorder of immune system. It includes Crohn's disease (CD) and ulcerative colitis (UC). Many factors such as environment and dysbiosis of gut microbiota can lead to IBD. TNF-α is generally considered as playing an important role in the development and progression of IBD. This article reviewed the role of TNF-α in the pathogenesis of IBD.
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The incidence of ulcerative colitis (UC) is increasing in recent years, and its pathogenesis is not completely clear. The extraintestinal manifestations (EIM) of UC are diverse and can involve multiple organ systems such as bone and joint, skin, liver and gallbladder, eye, etc. The incidence of one EIM increases the risk of development of other EIM. Cutaneous manifestations are important EIM of UC, and are usually classified into reactive, immunity-associated, malnutrition and treatment-induced manifestations. This article reviewed the clinical symptoms, diagnosis and treatment of cutaneous extraintestinal manifestations of UC.
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Background: Ulcerative colitis (UC) is often accompanied by a variety of extraintestinal manifestations (EIM). EIM is important for the diagnosis and treatment of UC. Aims: To investigate the risk factors of EIM in patients with UC. Methods: The clinical data of patients with UC from Jan. 2013 to Dec. 2018 at the People's Hospital of Xinjiang Autonomous Region were retrospectively analyzed. Univariate and multivariate analysis were performed to investigate the risk factors of EIM in UC. Results: A total of 260 UC patients were enrolled, of them 120 (46.2%) had EIM. The main EIM were musculoskeletal manifestation, skin disease, eye disease, hepatobiliary disease. Univariate analysis showed that Uyghur (χ2=4.069, P=0.044), older (χ2=4.250, P=0.039), BMI≥24 kg/m2 (χ2=13.913, P=0.000), history of intestinal surgery (χ2=6.089, P=0.014) and disease activity (χ2=27.556, P=0.000) were associated with EIM in UC patients. Multivariate analysis showed that Uyghur (OR=1.802, P=0.042), BMI≥24 kg/m2 (OR=3.163, P=0.000), history of intestinal surgery (OR=4.089, P=0.042) and disease activity (OR=6.347, P=0.000) were risk factors of EIM in UC patients. Conclusions: Uyghur, BMI≥24 kg/m2, history of intestinal surgery and disease activity are important risk factors of EIM in UC patients.
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Background:Ulcerative colitis(UC)is often accompanied by a variety of extraintestinal manifestations. Recently, the role of extraintestinal manifestations in diagnosis and treatment of UC has aroused widespread concern in clinical practice. Aims:To study the extraintestinal manifestations of patients with UC in order to elevate diagnosis level of UC. Methods:A total of 208 inpatients from June 2008 to September 2011 at Beijing Military General Hospital were enrolled. The extraintestinal manifestations of UC were retrospectively analyzed. Results:The ratio of male to female was 1. 14: 1, mean age was(41. 17 ± 13. 57)years,mean disease duration was(62. 6 ± 79. 4)months. Thirty-three patients had proctitis,52 had left-sided colitis,and 123 had extensive colitis. Forty-nine patients were mild UC,80 were moderate UC, and 79 were severe UC. The incidence of extraintestinal manifestations was 28. 8%(60 / 208);13 patients(6. 3% )had more than one extraintestinal manifestation. The main extraintestinal manifestations were oral ulcer(13. 0% ),arthropathy (11. 1% ),hepatobiliary disease( 3. 8% ) and skin lesion( 1. 4% ). The trend of incidence of extraintestinal manifestations increased from patients with proctitis,left-sided colitis to extensive colitis(21. 2% ,28. 8% ,30. 9% , respectively),however,the difference was not statistically significant(P > 0. 05). No significant difference in incidence of extraintestinal manifestations in patients with mild UC,moderate UC and severe UC was found(22. 4% ,33. 8% ,27. 8% , respectively)(P > 0. 05). Conclusions:Patients with UC are often accompanied by extraintestinal manifestations,and the recognition of extraintestinal manifestations is helpful for improving diagnosis and treatment level of UC.
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Crohn's disease (CD) is a chronic nonspecific inflammatory disease.CD can affect any location in the digestive tract,and it also affect other organs,including the eyes,skin,liver and joints,which are termed extraintestinal manifestations (EIMs).The cutaneous manifestations of CD are common and occur in about one-third of patients.EIMs of CD have been divided into 3 categories.(1) Specific lesion,cutaneous manifestations of CD were the same as histopathologic findings of underlying gastrointestinal lesion.(2) Reactive lesion,it was also inflammatory lesion which was usually accompanied by underlying gastrointestinal disease while inflammatory injury was different from histopathologic findings of gastrointestinal lesion.(3) Associated lesion,it was caused by sequelae of human leucocyte antigen and chronic inflammation.In the current era of ever-expanding therapeutic options for CD,some investigators have proposed a fourth category of EIMs,namely those that are therapy-related lesion.The therapy-related lesion is closely related to disease-associated conditions in light of certain skin findings,and there is potential overlap between them.
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Objective To explore the differences in disease location,pathological feature,disease severity,extraintestinal manifestations and drug treatment between inflammatory bowel disease (IBD) patients with comorbid autoimmune disease (AD) and simple IBD patients.Methods From January 2009 to December 2014,the clinical data of 54 IBD patients with comorbid AD and at the same period 74 simple hospitalized IBD patients were retrospectively analyzed.According to IBD type and whether combined with AD,patients were divided into Crohn's disease (CD)+AD group (n=16),CD group (n=26),ulcerative colitis (UC)+AD group (n=38) and UC group (n=48).Chi square test was performed to compare the differences in disease severity,location,extraintestinal manifestations and drug treatment between IBD patients with and without AD.Results There was no statistically significant difference in location among four groups (all P＞0.05).The most common concomitant AD of IBD was rheumatoid arthritis (20.4％,11/54) and ankylosing spondylitis (13.0％,7/54).The proportion of mild active patients of CD+ AD group was lower than that of CD group (2/16 vs 53.8％ (14/26),x2 =7.180,P=0.007),while the proportion of severe active patients was significantly higher that of CD group (6/16 vs 0,x2 =8.519,P=0.004).There was no statistically significant difference in moderate active patients between the two groups (P=0.808).Main type of patients of UC+ AD group (76.3 ％,29/38) and UC group (68.8 ％,33/48) were moderate active patients.There was no statistically significant difference in disease stage and location (all P＞0.05).The incidence of extraintestinal manifestations of IBD+AD group (55.6 ％,30/ 54) was significantly higher than that of IBD group (9.5 ％,7/74,x2 =32.279,P＜0.01),and the main manifestation was arthritis (37.0％ (20/54) vs 5.4％ (4/74),x2=20.504,P＜0.01).The rate of glucocorticoid and immunosuppressant application in IBD+AD group was higher than that of IBD group (40.7％ (22/54) vs 17.6％(13/74),x2 =8.438,P=0.004;20.4％(11/54) vs 0,x2=14.000,P＜ 0.01).Conclusions The condition of patients with IBD and comorbid AD is more severe,and the incidence of extraintestinal manifestations is higher.Early treated with glucocorticoid and immunosuppressant could effectively achieve remission.
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Background: Inflammatory bowel disease usually presents with gastrointestinal stigmata of weight loss, anaemia, and rectal bleeding, but may exhibit prominent extra-intestinal manifestations also such as joint symptoms, skin signs and some other auto-immune manifestations. During the last few years many authors have reported serious complications of IBD manifesting in the Ear-Nose-Throat (ENT) and influencing disease morbidity. Methods: Twenty four patients with active ulcerative colitis (mean age 45 years) were recruited prospectively along with 24 healthy age- and sex-matched controls. Otoscopy, tympanometry and pure tone audiometry were performed. Otoscopy and tympanometry were normal in all patients and controls. Pure tone audiometry showed sensorineural hearing loss over all frequencies in patients with inflammatory bowel disease and compared with controls. The otologic data including age of onset, family history of otologic problems, exposure to noise and audiometric findings were also reviewed. Results: Out of 48 patients with a history of IBD, 24 had documented SNHL, 17 of these patients had a diagnosis of ulcerative colitis and 7 had Crohn’s disease. 22 patients had bilateral SNHL, and 2 patients had unilateral SNHL. Tinnitis were the most common associated aural complaint. Conclusion: Sensorineural hearing loss is very unusual finding, possibly of auto-immune aetiology. We recommend steroid or immunosuppressive therapy in such a patient. Evidence for an autoimmune basis for this condition is reviewed and the potential benefit of systemic corticosteroids emphasized.
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Inlfammatory bowel disease (IBD) is characterized by chronic, relapsing inlfammation of the gastrointestinal (GI) tract. In recent years, the incidence is increasing in the pediatric population. Insufifcient recognition of extraintestinal manifestations (EIMs) of IBD clinically may delay diagnosis. Therefore, improving the recognition of EIMs of IBD has an important signiifcance in its early diagnosis and treatment. The pediatricians should be alerted that renal lesions of EIMs in IBD are mainly immunoglobulin A (IgA) nephropathy and interstitial nephritis.
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La colitis ulcerativa (CU) forma más común de la enfermedad inflamatoria intestinal (EII),¹ es una enfermedad crónica que cursa con inflamación recurrente no controlada del colon,² caracterizada por ulceración de la mucosa, sangrado rectal, diarrea y dolor abdominal.³ Un tercio de los pacientes pueden desarrollar una manifestación extraintestinal.4,5 En la CU estas manifestaciones suelen estar relacionadas con la actividad de la enfermedad.5,6 Presentamos un caso clínico de una paciente con CU quien presenta manifestaciones extraintestinales cutáneas, oculares y en mucosa bucal, con resolución de las mismas posterior a tratamiento médico
Ulcerative colitis (UC) the most common form of inflammatory bowel disease (IBD),¹ is a chronic disease that causes uncontrolled recurrent inflammation of the colon,² characterized by mucosal ulceration, rectal bleeding, diarrhea and abdominal pain.³ A third of patients may develop extraintestinal manifestation.4,5 In UC these manifestations are often associated with disease activity.5,6 We present a case of a patient with UC who presented extraintestinal cutaneous, ocular and oral mucosa, with resolution of the same post-treatment
Subject(s)
Female , Middle Aged , Colon/injuries , Inflammatory Bowel Diseases/surgery , Inflammatory Bowel Diseases/pathology , Colonic Diseases/diagnosis , Proctocolitis/surgery , Proctocolitis/diagnosis , GastroenterologyABSTRACT
Objectives To explore the clinical features, diagnosis and treatment of Crohn’s disease complicated by erythromelalgia (EM) in a pediatric case. Methods The clinical manifestation, results of laboratory testing and endoscopy, mutational analysis of the SCN9A gene, and the follow-up record were collected and analyzed based on review of literature to a thirteen-year-old girl with Crohn’s disease complicated by erythromelalgia. Results The patient experienced symptoms of anorexia, fatigue, diarrhea, dark red and swelling skin, increased skin temperature and burning pain in her both lower extremities during the course of disease. The endoscopic ifndings included multiple ulcerations and polypoid protrusion lesion in colon, and the pathological examination showed the local abscess formation in colonic mucosa. The mutation in SCN9A gene of the child was excluded by gene analysis. The symptoms were gradually ameliorated after treatment using prednisone and mesalazine combined with dipyridamole and low-molecular-weight heparin calcium. Conclusions Crohn’s disease complicated by erythromelalgia is rare. The pathogenesis may relate to immune factors, thrombocytosis, and hyper-coagulable states, etc. The combination of glucocorticoids, 5-aminosalicylic acid and anticoagulants may lead to a better therapeutic effect.
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OBJETIVO: conocer sobre los conocimientos, percepciones y prácticas de los dermatólogos de Ciudad de La Habana en relación con la infección por Giardia lamblia. MÉTODOS: previo consentimiento informado de los dermatólogos de Ciudad de La Habana, a un número próximo al universo de estos (50 de 58), se le aplicó una encuesta sobre conocimientos, percepciones y prácticas en relación con esta parasitosis. La preparación de la encuesta pasó por 4 fases: entrevistas a médicos relacionados con el diagnóstico, tratamiento y control de la giardiasis; preparación de un cuestionario preliminar sobre la base de los resultados de esas entrevistas; sometimiento del instrumento a criterio de expertos; y validación de este mediante su aplicación a un pequeño grupo de galenos. RESULTADOS: se evidenció que en relación con la giardiasis y, de manera particular, con las manifestaciones cutáneas asociadas a esta, los dermatólogos de Ciudad de La Habana mostraban conocimientos insuficientes (de 19 interrogantes que evaluaban aspectos cognoscitivos, la media de respuestas correctas entre todos los participantes fue 10,18), percepciones inadecuadas y prácticas incorrectas. CONCLUSIONES: en la dirección de atenuar estas dificultades se hace necesario una intervención de tipo académica, que haga énfasis en los aspectos formativos relacionados con las enfermedades parasitarias, en general, y la giardiasis, en particular.
OBJECTIVE: to ascertain the level of knowledge, the perceptions and practice of dermatologists in the City of Havana with respect to Giardia lamblia infection. METHODS: with prior informed consent given by the dermatologists from the City of Havana, 50 dermatologists- a number very close to the universe of these experts in the province- were administered a survey of their knowledge, perceptions and practice about this parasitosis. The survey was prepared in 4 phases; that is, interviews to physicians on diagnosis, treatment and control of giardiasis; drafting of a preliminary questionnaire based on the interview results; submission of this instruments to the experts, and finally its validation through its application to a small group of physicians. RESULTS: it was evinced that the dermatologists in the City of Havana had poor knowledge about giardiasis, particularly its cutaneous manifestations (out of 19 questions on cognitive aspects, the correct answer mean was 10,18), inadequate perceptions on this disease and practice was not good. CONCLUSIONS: with the aim of mitigating these difficulties, some academic intervention is needed to make emphasis on the formative aspects related to parasitic diseases in general and giardiasis in particular.
Subject(s)
Humans , Dermatology , Giardia lamblia , Giardiasis , Health Knowledge, Attitudes, Practice , Giardiasis/diagnosis , Giardiasis/therapyABSTRACT
Estudio sobre los conocimientos, percepciones y prácticas de los gastroenterólogos de Ciudad de La Habana, en relación con la infección por Giardia lamblia. Previo consentimiento informado, a los gastroenterólogos que prestaban servicios en la red de hospitales e institutos de investigaciones de Ciudad de La Habana en el período que se realizó la investigación (63 de 71) se les aplicó una encuesta sobre conocimientos, percepciones y prácticas en relación con esta parasitosis. La preparación de la encuesta pasó por cuatro fases: 1) entrevistas a médicos relacionados con el diagnóstico, tratamiento y control de la giardiasis; 2) preparación de un cuestionario preliminar en base a los resultados de esas entrevistas; 3) sometimiento del instrumento a criterio de expertos y 4) validación del mismo mediante su aplicación a un pequeño grupo de galenos. Se evidenció que en relación con la giardiasis y, de manera particular, con las manifestaciones cutáneas asociadas a esta, los gastroenterólogos mostraban conocimientos insuficientes (de 19 interrogantes que evaluaban aspectos cognoscitivos, la media de respuestas correctas entre todos los participantes fue de 9,87), y algunas percepciones inadecuadas. En la dirección de atenuar estas dificultades se hace necesaria una intervención de tipo académica que permita perfeccionar el trabajo de los profesionales relacionados con el diagnóstico, tratamiento y control de esta parasitosis(AU)
To ascertain the level of knowledge, the perceptions and practice of gastroenterologists in the City of Havana with respect to Giardia lamblia infection. Methos: with prior informed consent given by the gastroenterologist from the City of Havana, to 63 gastroenterologists- a number very close to the universe of these experts in the province- were administered a survey of their knowledge, perceptions and practice about this parasitosis. The survey was prepared in 4 phases; that is, interviews to physicians on diagnosis, treatment and control of giardiasis; drafting of a preliminary questionnaire based on the interview results; submission of this instruments to the experts, and finally its validation through its application to a small group of physicians. Results: it was evidenced that the gastroenterologists in the City of Havana had poor knowledge about giardiasis, particularly its cutaneous manifestations (out of 19 questions on cognitive aspects, the correct answer mean was 9,87) and some inadequate perceptions. Conclusions: with the aim of mitigating these difficulties, some academic intervention is needed to improve the work in relation to parasitic diseases in general and giardiasis in particular(AU)