Limits...
Skin gangrene as an extraintestinal manifestation of inflammatory bowel disease.

Komatsu YC, Capareli GC, Boin MF, Lellis R, Freitas TH, Simone K - An Bras Dermatol (2014 Nov-Dec)

Bottom Line: The most frequent cutaneous or mucocutaneous manifestations suggesting ulcerative rectocolitis activity are erythema nodosum (3-10%), pyoderma gangrenosum (5-12%) and aphthous stomatitis (4%).We describe the case of a young man with diagnosis of ulcerative rectocolitis, which presented an extensive cutaneous gangrene secondary to microvascular thrombosis.The case represents a dermatologic rarity and should be recognized as a cutaneous manifestation related to the hypercoagulability state observed in the disease's activity.

View Article: PubMed Central - PubMed

Affiliation: Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

ABSTRACT
Inflammatory bowel diseases can commonly present many cutaneous lesions which can contribute to the diagnosis of the disease or its activity. The most frequent cutaneous or mucocutaneous manifestations suggesting ulcerative rectocolitis activity are erythema nodosum (3-10%), pyoderma gangrenosum (5-12%) and aphthous stomatitis (4%). Other reactive skin manifestations related to immunological mechanisms associated with the inflammatory bowel disease are: Sweet's syndrome, arthritis-dermatitis syndrome associated with inflammatory bowel disease and leukocytoclastic vasculitis. We describe the case of a young man with diagnosis of ulcerative rectocolitis, which presented an extensive cutaneous gangrene secondary to microvascular thrombosis. The case represents a dermatologic rarity and should be recognized as a cutaneous manifestation related to the hypercoagulability state observed in the disease's activity.

Show MeSH

Related in: MedlinePlus

Microvascular thrombosis, without signs of vasculitis
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4230667&req=5

f03: Microvascular thrombosis, without signs of vasculitis

Mentions: 29-year-old man, of mixed race, with a history of ulcerative rectocolitis, had used onlysulfasalazine for 3 years, with a history of onset of 2 erythematous areas on the leftflank, measuring about 7 cm, with well-defined limits, initially painful, which hadevolved to fast-progression necrosis 5 days before (Figure 1). One of the lesions presented a peripheral blister (Figure 2). The left breast presented a painful tumorwith hardened consistency for 1 month. He appeared to be in good general condition,afebrile and with no complaint of abdominal pains. The laboratory tests demonstratednormocytic normochromic anemia, discreet thrombocytosis (467,000platelets/mm3), ESR 62 mm/1st hour and CRP 4.3 mg/dl, abnormal liverfunction (SGOT 83U/L, ALT 91 U/L, albumin 2.8 g/100ml), very high canalicular enzymes(FA = 1079 U/L, GGT = 665 U/L) and urine 1 with mild proteinuria (0.25mg protein/ml).The research of cryoglobulins and immune complexes (ELISA) was negative. Plateletfunction and prothrombin time were normal. He underwent biopsy of the edge of the skinlesion from which histopathological examination revealed microvascular thrombosiswithout signs of vasculitis (Figure 3).Mammography of the left breast showed focal asymmetry in the retroareolar region, whichanatomopathological examination revealed only glandular breast tissue without changes(Figure 4). Under the conditions presented, thediagnostic hypothesis for cutaneous gangrene associated with possible mastitis was made.The treatment of this patient included prednisone (1 mg/kg/day) and sulfasalazine, withgood evolution and progressive improvement of skin lesion.


Skin gangrene as an extraintestinal manifestation of inflammatory bowel disease.

Komatsu YC, Capareli GC, Boin MF, Lellis R, Freitas TH, Simone K - An Bras Dermatol (2014 Nov-Dec)

Microvascular thrombosis, without signs of vasculitis
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230667&req=5

f03: Microvascular thrombosis, without signs of vasculitis
Mentions: 29-year-old man, of mixed race, with a history of ulcerative rectocolitis, had used onlysulfasalazine for 3 years, with a history of onset of 2 erythematous areas on the leftflank, measuring about 7 cm, with well-defined limits, initially painful, which hadevolved to fast-progression necrosis 5 days before (Figure 1). One of the lesions presented a peripheral blister (Figure 2). The left breast presented a painful tumorwith hardened consistency for 1 month. He appeared to be in good general condition,afebrile and with no complaint of abdominal pains. The laboratory tests demonstratednormocytic normochromic anemia, discreet thrombocytosis (467,000platelets/mm3), ESR 62 mm/1st hour and CRP 4.3 mg/dl, abnormal liverfunction (SGOT 83U/L, ALT 91 U/L, albumin 2.8 g/100ml), very high canalicular enzymes(FA = 1079 U/L, GGT = 665 U/L) and urine 1 with mild proteinuria (0.25mg protein/ml).The research of cryoglobulins and immune complexes (ELISA) was negative. Plateletfunction and prothrombin time were normal. He underwent biopsy of the edge of the skinlesion from which histopathological examination revealed microvascular thrombosiswithout signs of vasculitis (Figure 3).Mammography of the left breast showed focal asymmetry in the retroareolar region, whichanatomopathological examination revealed only glandular breast tissue without changes(Figure 4). Under the conditions presented, thediagnostic hypothesis for cutaneous gangrene associated with possible mastitis was made.The treatment of this patient included prednisone (1 mg/kg/day) and sulfasalazine, withgood evolution and progressive improvement of skin lesion.

Bottom Line: The most frequent cutaneous or mucocutaneous manifestations suggesting ulcerative rectocolitis activity are erythema nodosum (3-10%), pyoderma gangrenosum (5-12%) and aphthous stomatitis (4%).We describe the case of a young man with diagnosis of ulcerative rectocolitis, which presented an extensive cutaneous gangrene secondary to microvascular thrombosis.The case represents a dermatologic rarity and should be recognized as a cutaneous manifestation related to the hypercoagulability state observed in the disease's activity.

View Article: PubMed Central - PubMed

Affiliation: Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

ABSTRACT
Inflammatory bowel diseases can commonly present many cutaneous lesions which can contribute to the diagnosis of the disease or its activity. The most frequent cutaneous or mucocutaneous manifestations suggesting ulcerative rectocolitis activity are erythema nodosum (3-10%), pyoderma gangrenosum (5-12%) and aphthous stomatitis (4%). Other reactive skin manifestations related to immunological mechanisms associated with the inflammatory bowel disease are: Sweet's syndrome, arthritis-dermatitis syndrome associated with inflammatory bowel disease and leukocytoclastic vasculitis. We describe the case of a young man with diagnosis of ulcerative rectocolitis, which presented an extensive cutaneous gangrene secondary to microvascular thrombosis. The case represents a dermatologic rarity and should be recognized as a cutaneous manifestation related to the hypercoagulability state observed in the disease's activity.

Show MeSH
Related in: MedlinePlus