Sweet Syndrome Associated with Active Inflammatory Bowel Disease: A Case Series of a Rare Extra-intestinal Manifestation.

Female Male Humans Colitis, Ulcerative / diagnosis Crohn Disease / diagnosis Retrospective Studies Sweet Syndrome / diagnosis Inflammatory Bowel Diseases / complications
Azathioprine Colitis Cutaneous manifestations Extra-intestinal manifestation Inflammatory bowel disease Sweet syndrome

Journal

Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782

Informations de publication

Date de publication:
09 2023
Historique:
received: 27 02 2023
accepted: 22 05 2023
medline: 24 8 2023
pubmed: 5 7 2023
entrez: 4 7 2023
Statut: ppublish

Résumé

Cutaneous extra-intestinal manifestations (EIM) occur in up to 20% of patients with IBD. Information about Sweet syndrome (SS)'s clinical course as a rare cutaneous EIM in IBD is limited to case reports. We present the largest retrospective cohort on the occurrence and management of SS in IBD. Electronic medical records and paper charts since 1980 were retrospectively reviewed at a large quaternary medical center to identify all adult IBD patients with histopathology-proven SS. Patient characteristics and clinical outcomes were evaluated. 25 IBD patients with SS were identified; 3 patients were assessed to have AZA-induced SS. The majority of SS patients were female. Median age at diagnosis was 47 years (IQR 33-54 years) and SS appeared at a median of 6.4 years after IBD diagnosis. IBD patients with SS had a high rate of complicated IBD phenotypes (75% extensive colitis in UC and 73% stricturing or penetrating disease in CD, with 100% colonic involvement), as well as frequent co-occurring EIMs (60%). SS correlated with global IBD disease activity. Corticosteroids were an effective therapy for SS in IBD. Recurrence rate of SS was 36%. Contrary to previous case reports, SS was a cutaneous EIM occurring late after diagnosis of IBD in our cohort, with occurrences paralleling global IBD disease activity. Although AZA-induced and IBD-associated SS were both effectively treated with corticosteroids, distinguishing them is relevant for future IBD treatment strategies.

Sections du résumé

BACKGROUND
Cutaneous extra-intestinal manifestations (EIM) occur in up to 20% of patients with IBD. Information about Sweet syndrome (SS)'s clinical course as a rare cutaneous EIM in IBD is limited to case reports. We present the largest retrospective cohort on the occurrence and management of SS in IBD.
STUDY
Electronic medical records and paper charts since 1980 were retrospectively reviewed at a large quaternary medical center to identify all adult IBD patients with histopathology-proven SS. Patient characteristics and clinical outcomes were evaluated.
RESULTS
25 IBD patients with SS were identified; 3 patients were assessed to have AZA-induced SS. The majority of SS patients were female. Median age at diagnosis was 47 years (IQR 33-54 years) and SS appeared at a median of 6.4 years after IBD diagnosis. IBD patients with SS had a high rate of complicated IBD phenotypes (75% extensive colitis in UC and 73% stricturing or penetrating disease in CD, with 100% colonic involvement), as well as frequent co-occurring EIMs (60%). SS correlated with global IBD disease activity. Corticosteroids were an effective therapy for SS in IBD. Recurrence rate of SS was 36%.
CONCLUSION
Contrary to previous case reports, SS was a cutaneous EIM occurring late after diagnosis of IBD in our cohort, with occurrences paralleling global IBD disease activity. Although AZA-induced and IBD-associated SS were both effectively treated with corticosteroids, distinguishing them is relevant for future IBD treatment strategies.

Identifiants

DOI: 10.1007/s10620-023-07983-5 PMID: 37402983
pubmed: 37402983
doi: 10.1007/s10620-023-07983-5
pii: 10.1007/s10620-023-07983-5
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

3562-3568

Subventions

Organisme : NIDDK NIH HHS
ID : R01 DK123233
Pays : United States

Informations de copyright

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Références

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doi: 10.1097/mib.0000000000000429 pubmed: 26020601
Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn’s disease and ulcerative colitis: a study of 700 patients. Medicine (Baltimore). 1976;55:401–412. https://doi.org/10.1097/00005792-197609000-00004 .
doi: 10.1097/00005792-197609000-00004 pubmed: 957999
Cohen PR. Sweet’s syndrome–a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis. 2007;2:34. https://doi.org/10.1186/1750-1172-2-34 .
doi: 10.1186/1750-1172-2-34 pubmed: 17655751
Sleiman J, Hitawala AA, Cohen B et al. Systematic review: Sweet syndrome associated with inflammatory bowel disease. J Crohns Colitis. 2021. https://doi.org/10.1093/ecco-jcc/jjab079 .
doi: 10.1093/ecco-jcc/jjab079 pubmed: 33891004 pmcid: 8675328
Falloon K, Cohen B, Ananthakrishnan AN et al. A United States expert consensus to standardise definitions, follow-up, and treatment targets for extra-intestinal manifestations in inflammatory bowel disease. Aliment Pharmacol Ther. 2022. https://doi.org/10.1111/apt.16853 .
doi: 10.1111/apt.16853 pubmed: 35429040 pmcid: 10022869
Guillo L, Abreu M, Panaccione R et al. Endpoints for extraintestinal manifestations in inflammatory bowel disease trials: the EXTRA consensus from the International Organization for the Study of Inflammatory Bowel Diseases. Lancet Gastroenterol Hepatol. 2022;7:254–261. https://doi.org/10.1016/S2468-1253(21)00297-1 .
doi: 10.1016/S2468-1253(21)00297-1 pubmed: 35051383
Rochet NM, Chavan RN, Cappel MA, Wada DA, Gibson LE. Sweet syndrome: clinical presentation, associations, and response to treatment in 77 patients. J Am Acad Dermatol. 2013;69:557–564. https://doi.org/10.1016/j.jaad.2013.06.023 .
doi: 10.1016/j.jaad.2013.06.023 pubmed: 23891394
Karreman MC, Luime JJ, Hazes JMW, Weel AEAM. The prevalence and incidence of axial and peripheral spondyloarthritis in inflammatory bowel disease: a systematic review and meta-analysis. J Crohns Colitis. 2016. https://doi.org/10.1093/ecco-jcc/jjw199 .
doi: 10.1093/ecco-jcc/jjw199

Auteurs

Joseph Sleiman (J)

Department of Internal Medicine, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA.
Division of Gastroenterology, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Mihir Patel (M)

Department of Internal Medicine, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA.

Muhammad Zarrar Khan (MZ)

Department of Internal Medicine, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA.

Katherine Falloon (K)

Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.

Benjamin Cohen (B)

Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.

Benjamin Click (B)

Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Colorado University Anschutz Medical Campus, Aurora, CO, USA.

Urmi Khanna (U)

Department of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.

Anthony P Fernandez (AP)

Departments of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Dermatology, Dermatology & Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.

Florian Rieder (F)

Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. riederf@ccf.org.
Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. riederf@ccf.org.
Center for Global Translational Inflammatory Bowel Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA. riederf@ccf.org.
ORCID: 0000-0002-9087-1568

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Sweet Syndrome Associated with Active...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies inflammatoires intestinales › Rectocolite hémorragique › Sweet Syndrome Associated with Active...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies inflammatoires intestinales › Maladie de Crohn › Sweet Syndrome Associated with Active...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Sweet Syndrome Associated with Active...
questionsmedicales.fr › Maladies de la peau et du tissu conjonctif › Maladies de la peau › Syndrome de Sweet › Sweet Syndrome Associated with Active...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies inflammatoires intestinales › Sweet Syndrome Associated with Active...