RESUMO
Inflammatory bowel disease is accompanied by extraintestinal manifestations in a high percentage of patients. Cutaneous lesions are the second most prevalent of these manifestations, and within these, metastatic Crohn's disease is one of the least common, being the least frequent specific cutaneous manifestation of Crohn's disease. This entity includes cutaneous and subcutaneous lesions with a non-caseating granulomatous appearance on histological analysis identical to that of Crohn's disease. These lesions are not found adjacent to the digestive tract. Due to the low prevalence of these manifestations, conclusive trials on the treatment of choice have not been performed and there is no well-defined therapeutic strategy. Distinct therapies with varying results have been reported. We report the case of a female patient with longstanding and complex Crohn's disease who developed metastatic cutaneous manifestations while receiving adalimumab. The cutaneous manifestations responded well to dose intensification of this drug. A review of the literature is provided.
Assuntos
Anti-Inflamatórios/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Doença de Crohn/complicações , Dermatopatias/tratamento farmacológico , Dermatopatias/etiologia , Adalimumab , Adulto , Feminino , Humanos , Indução de RemissãoAssuntos
Produtos Biológicos/uso terapêutico , Doença de Crohn/tratamento farmacológico , Transplante de Fígado , Adalimumab , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Produtos Biológicos/efeitos adversos , Doença de Crohn/imunologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Masculino , Tacrolimo/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidoresAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Hidrotórax/complicações , Hidrotórax/diagnóstico , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Encefalopatia Hepática/complicações , Encefalopatia Hepática/diagnóstico , Constipação Intestinal/complicações , Antibacterianos/uso terapêutico , Diuréticos/uso terapêutico , Encefalopatia Hepática/fisiopatologia , Encefalopatia Hepática , Radiografia Torácica/tendências , Radiografia Torácica , /instrumentação , /métodos , Ascite/complicações , AsciteRESUMO
Resumen La enfermedad inflamatoria intestinal se acompaña de manifestaciones extraintestinales en un elevado porcentaje de pacientes. Las manifestaciones cutáneas son las segundas en prevalencia, y dentro de ellas, la enfermedad de Crohn metastásica es una de la más raras, siendo de hecho la forma menos frecuente de manifestación cutánea específica de la enfermedad de Crohn. Esta entidad reúne lesiones cutáneas y subcutáneas con una histología granulomatosa no caseificante idéntica a la enfermedad de Crohn, que no se encuentran contiguas al tracto digestivo. Precisamente, debido a su escasa prevalencia, no se han podido realizar ensayos concluyentes sobre su tratamiento de elección, no existiendo una estrategia terapéutica definida y habiéndose comunicado el empleo de diversas terapias con resultado variable. Presentamos el caso de una paciente con enfermedad de Crohn de evolución larga y compleja, que estando en tratamiento con adalimumab desarrolló una enfermedad de Crohn metastásica cutánea que respondió tras intensificar el tratamiento con el mismo anti-TNF. Se realiza una revisión de la literatura médica (AU)
Abstract Inflammatory bowel disease is accompanied by extraintestinal manifestations in a high percentage of patients. Cutaneous lesions are the second most prevalent of these manifestations, and within these, metastatic Crohn's disease is one of the least common, being the least frequent specific cutaneous manifestation of Crohn's disease. This entity includes cutaneous and subcutaneous lesions with a non-caseating granulomatous appearance on histological analysis identical to that of Crohn's disease. These lesions are not found adjacent to the digestive tract. Due to the low prevalence of these manifestations, conclusive trials on the treatment of choice have not been performed and there is no well-defined therapeutic strategy. Distinct therapies with varying results have been reported.We report the case of a female patient with longstanding and complex Crohn's disease who developed metastatic cutaneous manifestations while receiving adalimumab. The cutaneous manifestations responded well to dose intensification of this drug. A review of the literature is provided (AU)