RESUMEN
Cutaneous Crohn disease, sometimes called metastatic Crohn disease or Crohn disease with cutaneous involvement, is a rare complication of Crohn disease in which granulomatous lesions involve skin separated from gastrointestinal lesions by normal tissue. We report two cases of cutaneous Crohn disease presenting in young males with erythematous, nontender swelling of the scrotum. One of the young males presented erythematous, nontender swelling of the penis as well. In one case, cutaneous Crohn disease represented the primary presentation. The original biopsy in this case showed unusual areas of degeneration of dermal connective tissue forming cystic cavities. The diagnostic biopsies in both cases showed sarcoidal granulomas with an associated superficial and deep perivascular mixed infiltrate including eosinophils. On endoscopy, both patients showed lesions of active Crohn disease in the colon. Because changes that would suggest cutaneous Crohn disease may not be present on the initial biopsy, unusual presentations and negative cultures may warrant a second biopsy. A high index of suspicion and open communication with the clinician are essential to diagnose this disease.
Asunto(s)
Enfermedad de Crohn/patología , Enfermedades del Pene/patología , Enfermedades de la Piel/patología , Enfermedades Testiculares/patología , Adolescente , Adulto , Colitis/diagnóstico , Humanos , MasculinoRESUMEN
Crohn's disease primarily affects the distal gastrointestinal tract, yet it is a systemic disease that can involve nearly any organ. A psoas abscess complicating Crohn's disease is uncommon and usually originates from a fistulous communication with an adherent bowel. Spinal epidural abscess, an extremely rare complication, also appears to arise by fistulization from another organ involved with Crohn's disease. Previous reports indicate that abscesses in these two areas usually contain bacterial organisms, often mixed flora, consistent with seeding from a diseased bowel. This report represents the first case of Crohn's disease complicated by both bilateral sterile psoas abscesses and a coexistent sterile epidural abscess without evidence of a fistulous communication from the bowel. We report this case because psoas and epidural abscesses can present without typical signs and symptoms. Once suspected, aggressive diagnostic workup and definitive operative intervention is indicated. Failure to promptly diagnose and treat these abscesses may result in considerable morbidity.
Asunto(s)
Enfermedad de Crohn/complicaciones , Absceso del Psoas/complicaciones , Enfermedades de la Columna Vertebral/complicaciones , Adulto , Espacio Epidural , Femenino , Humanos , Absceso del Psoas/microbiología , Enfermedades de la Columna Vertebral/microbiologíaRESUMEN
The irritable bowel syndrome is a common disorder of gastrointestinal motility. Abdominal pain, bloating, and inconsistent bowel habits are the hallmark symptoms of irritable bowel syndrome. Fever, weight loss, and gastrointestinal bleeding often indicate more serious pathologic gastrointestinal conditions, such as inflammatory bowel disease or infectious enteritis. Because irritable bowel syndrome is so prevalent in our society, the primary care physician should be able to readily recognize the clinical features of this disorder in order to spare patients expensive, unnecessary diagnostic and therapeutic interventions. In this review, the authors discuss the clinical and psychological features of irritable bowel syndrome and offer a useful approach to the diagnosis and treatment of this disorder.