Metastatic Crohn’s disease: a difficult diagnosis from different perspectives
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| Format: | Artículo científico |
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Asociación Colombiana de Gastroenterologia
2023
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| author | Viviana Parra-Izquierdo, |
| author_facet | Viviana Parra-Izquierdo, |
| contents | Metastatic Crohn’s disease: a difficult diagnosis from different perspectives Viviana Parra-Izquierdo, Juan Sebastián Frías-Ordóñez, Natalia Lozano, Consuelo Romero-Sánchez Julio Andrés Alvarado Cristian Florez Medicina vulva granuloma Crohn’s disease oral manifestations cutaneous manifestations Metastatic Crohn’s disease (MCD) is a rare cutaneous manifestation of Crohn’s disease (CD). The simultaneous involvement of the vulva and oral region is uncommon in clinical presentations of MCD. We present the case of a middle-aged woman with a family history of autoimmunity who initially presented with oral and vulvoperineal involvement. Initially, Behçet’s disease was ruled out, but histopathological studies of the vulva revealed findings compatible with MCD. The patient had no gastrointestinal symptoms, and fecal calprotectin levels were normal. Upper and lower endoscopic examinations and capsule endoscopy of the small intestine (SI) did not reveal any significant findings. Treatment with anti-tumor necrosis factor (anti-TNF) agents was initiated but resulted in paradoxical psoriasis with adalimumab and infliximab. Cyclosporine was also used, but the patient experienced intolerable tachycardia. After 18 months, the patient developed episcleritis and experienced diarrhea accompanied by cramp-like abdominal pain. Repeat upper and lower endoscopic examinations showed normal results, while capsule endoscopy of the SI revealed CD enteritis. The patient was diagnosed with CD of the small intestine, along with extraintestinal manifestations of vulvoperineal MCD, oral involvement, and episcleritis. Management with azathioprine and ustekinumab was initiated, resulting in significant clinical improvement. MCD poses a diagnostic challenge due to its unusual manifestations. It may present without gastrointestinal tract involvement, mimicking other conditions. Therefore, timely diagnosis and the selection of the most appropriate therapeutic strategy are crucial. 2023 otro 0120-9957 https://www.redalyc.org/articulo.oa?id=337779490010 https://www.redalyc.org/journal/3377/337779490010/ https://www.redalyc.org/journal/3377/337779490010/html/ https://www.redalyc.org/journal/3377/337779490010/337779490010.epub https://www.redalyc.org/journal/3377/337779490010/movil 10.22516/25007440.910 en http://www.redalyc.org/revista.oa?id=3377 Revista Colombiana de Gastroenterología application/pdf Asociación Colombiana de Gastroenterologia Revista Colombiana de Gastroenterología (Colombia) Num.2 Vol.38 |
| format | Artículo científico |
| id | redalyc_337779490010 |
| institution | Redalyc |
| language | en |
| publishDate | 2023 |
| publisher | Asociación Colombiana de Gastroenterologia |
| spellingShingle | Metastatic Crohn’s disease: a difficult diagnosis from different perspectives Viviana Parra-Izquierdo, Medicina vulva granuloma Crohn’s disease oral manifestations cutaneous manifestations Metastatic Crohn’s disease: a difficult diagnosis from different perspectives Viviana Parra-Izquierdo, Juan Sebastián Frías-Ordóñez, Natalia Lozano, Consuelo Romero-Sánchez Julio Andrés Alvarado Cristian Florez Medicina vulva granuloma Crohn’s disease oral manifestations cutaneous manifestations Metastatic Crohn’s disease (MCD) is a rare cutaneous manifestation of Crohn’s disease (CD). The simultaneous involvement of the vulva and oral region is uncommon in clinical presentations of MCD. We present the case of a middle-aged woman with a family history of autoimmunity who initially presented with oral and vulvoperineal involvement. Initially, Behçet’s disease was ruled out, but histopathological studies of the vulva revealed findings compatible with MCD. The patient had no gastrointestinal symptoms, and fecal calprotectin levels were normal. Upper and lower endoscopic examinations and capsule endoscopy of the small intestine (SI) did not reveal any significant findings. Treatment with anti-tumor necrosis factor (anti-TNF) agents was initiated but resulted in paradoxical psoriasis with adalimumab and infliximab. Cyclosporine was also used, but the patient experienced intolerable tachycardia. After 18 months, the patient developed episcleritis and experienced diarrhea accompanied by cramp-like abdominal pain. Repeat upper and lower endoscopic examinations showed normal results, while capsule endoscopy of the SI revealed CD enteritis. The patient was diagnosed with CD of the small intestine, along with extraintestinal manifestations of vulvoperineal MCD, oral involvement, and episcleritis. Management with azathioprine and ustekinumab was initiated, resulting in significant clinical improvement. MCD poses a diagnostic challenge due to its unusual manifestations. It may present without gastrointestinal tract involvement, mimicking other conditions. Therefore, timely diagnosis and the selection of the most appropriate therapeutic strategy are crucial. 2023 otro 0120-9957 https://www.redalyc.org/articulo.oa?id=337779490010 https://www.redalyc.org/journal/3377/337779490010/ https://www.redalyc.org/journal/3377/337779490010/html/ https://www.redalyc.org/journal/3377/337779490010/337779490010.epub https://www.redalyc.org/journal/3377/337779490010/movil 10.22516/25007440.910 en http://www.redalyc.org/revista.oa?id=3377 Revista Colombiana de Gastroenterología application/pdf Asociación Colombiana de Gastroenterologia Revista Colombiana de Gastroenterología (Colombia) Num.2 Vol.38 |
| title | Metastatic Crohn’s disease: a difficult diagnosis from different perspectives |
| topic | Medicina vulva granuloma Crohn’s disease oral manifestations cutaneous manifestations |
| url | https://www.redalyc.org/articulo.oa?id=337779490010 https://www.redalyc.org/journal/3377/337779490010/ https://www.redalyc.org/journal/3377/337779490010/html/ https://www.redalyc.org/journal/3377/337779490010/337779490010.epub https://www.redalyc.org/journal/3377/337779490010/movil |