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Disseminated Aseptic Abscesses Associated with Crohn's Disease (A New Entity?)

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Abstract

Our purpose is to describe seven cases ofdisseminated aseptic abscesses with regard to clinical,biological, radiological, and histological information,treatment, and outcome. Data were collected on seven Caucasian patients who had proven sterile deepabscesses diagnosed in French university hospitals. Theonset of the disease related to abscesses began at timesfrom June 1988 to August 1994. Follow-up periods were 1 year, 7 months to 8 years, 2 months. Theage of the patients ranged from 15 to 26 years old. Atonset, all had fever and six had abdominal pain.Abscesses involved spleen and abdominal lymph nodes in six cases; liver in three; pancreas, brain,and chest in one. All had polymorphonuclearleukocytosis. Pathological examination showedgranulomatous abscesses. Direct and indirectinvestigations failed to identify any causal microorganism. On sixoccasions, Crohn's disease was revealed 1 to 41 monthslater and in one case, it preceded the onset ofabscesses. One subsequently developed Sweet's syndrome. Various antibiotic regimes were inefficient.Steroids, associated in three cases withimmunosuppressive agents, resulted in a rapidimprovement in six patients. In one case, splenectomyfollowed by 5-ASA therapy was used successfully. The dramaticeffectiveness of steroids and immunosuppressive agentsas well as follow-up suggest that disseminated asepticabscesses might be an extraintestinal manifestation of Crohn's disease. Although the pathogenesisof this condition remains unknown, this entity may berelated to neutrophilic dermatosis in which sterile deepabscesses have been reported.

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REFERENCES

  1. Danzi JT: Extraintestinal manifestations of idiopathic inflammatory bowel disease. Arch Intern Med 148:297–302, 1988

    Google Scholar 

  2. Andre M, Aumaitre O, Marcheix JC, Piette JC: Aseptic systemic abscesses preceding diagnosis of Crohn's disease by three years. Dig Dis Sci 40:525'527, 1995

    Google Scholar 

  3. Clamp SE, Myren J, Bouchier IAD, Watkinson G, de Dombal FT: Diagnosis of inflammatory bowel disease: An international multicentre scoring system. Br Med J 284:91–95, 1982

    Google Scholar 

  4. Delahoussaye PM, Osborne BM: Cat-scratch disease presenting as abdominal visceral granulomas. J Infect Dis 161:71–78, 1990

    Google Scholar 

  5. Saebo A, Lassen J: Acute and chronic gastrointestinal manifestations associated with Yersinia enterocoliticainfection: A Norwegian 10-year follow-up study on 458 hospitalized patients. Ann Surg 215:250–255, 1992

    Google Scholar 

  6. Greenstein AJ, Sachar DB, Greenstein RJ, Janowitz HD, Aufses AH Jr: Intraabdominal abscess in Crohn's (ileo) colitis. Am J Surg 143:727–730, 1982

    Google Scholar 

  7. Vakil N, Hayne G, Sharma A, Hardy DJ, Slutsky A: Liver abscess in Crohn's disease. Am J Gastroenterol 89:10901095, 1994

    Google Scholar 

  8. Nichols TW Jr, Wright FM, Pyeatte JC, O'Connell JP: Spontaneous rupture of the spleen. An unusual complication of Crohn's disease. Am J Gastroenterol 75:226–228, 1981

    Google Scholar 

  9. Wechter DG, Willson RA: Splenic abscess: A rare complication of Crohn's colitis. Dig Dis Sci 30:802–806, 1985

    Google Scholar 

  10. Malech HL, Gallin JI: Neutrophils in human diseases. N Engl J Med 317:687–694, 1987

    Google Scholar 

  11. Sloan JM, Cameron CHS, Maxwell RJ, McCluskey DR, Collins JSA: Colitis complicating chronic granulomatous disease. A clinicopathological case report. Gut 38:619–622, 1996

    Google Scholar 

  12. Thach BT, Cummings NA: Behçet syndrome with “aphthous colitis.” Arch Intern Med 136:705–709, 1976

    Google Scholar 

  13. Lemley DE, Chun B, Cupps TR: Sterile splenic abscesses in systemic Weber-Christian disease. Unique source of abdominal pain. Am J Med 83:567–570, 1987

    Google Scholar 

  14. Holmes GKT: Mesenteric lymph node cavitation in coeliac disease. Gut 27:728–733, 1986

    Google Scholar 

  15. Zaman A, Bramley PN, Wyatt J, Simmons A, Losowsky MS, Bolton R: Hodgkin's disease presenting as liver abscesses. Gut 32:959–962, 1991

    Google Scholar 

  16. Camus P, Piard F, Ashcroft T, Gal AA, Colby TV. The lung in inflammatory bowel disease. Medicine (Baltimore) 72:151–183, 1993

    Google Scholar 

  17. Lossos A, River Y, Eliakim A, Steiner I: Neurologic aspects of inflammatory bowel disease. Neurology 45:416–421, 1995

    Google Scholar 

  18. Dew MJ, Thompson H, Allan RN: The spectrum of hepatic dysfunction in inflammatory bowel disease. Q J Med 48:113135, 1979

    Google Scholar 

  19. Donaldson LB. Crohn's disease: Its gynecologic aspect. Am J Obstet Gynecol 131:196–202, 1978

    Google Scholar 

  20. Bartnik W, Krynski J, Butruk E, Orlowska J: Miliary Crohn's disease. Br Med J 1:1135–1136, 1977

    Google Scholar 

  21. McCallum DI, Gray WM: Metastatic Crohn's disease. Br J Dermatol 95:551–554, 1976

    Google Scholar 

  22. Cook MG: The size and histological appearances of mesenteric lymph nodes in Crohn's disease. Gut 13:970–972, 1972

    Google Scholar 

  23. Kemmett D, Gawkrodger DJ, Wilson G, Hunter JA: Sweet's syndrome in Crohn's disease. Br Med J 297:15131514, 1988

    Google Scholar 

  24. Matta M, Malak J, Tabet E, Kurban AK: Sweet's syndrome: Systemic associations. Cutis 12:561–565, 1973

    Google Scholar 

  25. Lazarus AA, McMillan M, Miramadi A: Pulmonary involve-ment in Sweet's syndrome (acute febrile neutrophilic dermatosis). Chest 90:922–924, 1986

    Google Scholar 

  26. Attias D, Laor R, Zuckermann E, Naschitz JE, Luria M, Misselevitch, I, Boss JH: Acute neutrophilic myositis in Sweet's syndrome: Late phase transformation into fibrosing myositis and panniculitis. Hum Pathol 26:688–690, 1995

    Google Scholar 

  27. Dallot A, Decazes JM, Drouault Y, Rvbojad M, Verola O, Morel P, Modai J, Puissant A: Subcorneal pustular dermatosis (Sneddon-Wilkinson disease) with amicrobial lymph node suppuration and aseptic spleen abscesses. Br J Dermatol 119:803–807, 1988

    Google Scholar 

  28. Cohen PR, Kurzrock R: The pathogenesis of Sweet's syndrome. J Am Acad Dermatol 25:734, 1991

    Google Scholar 

  29. Stevens C, Walz G, Singaram C, Lipman, ML, Zanker B, Muggia A, Antonioli D, Peppercorn MA, Strom TB: Tumor necrosis factor-α, interleukin-1β, and interleukin-6 expression in inflammatory bowel disease. Dig Dis Sci 37:818–826, 1992

    Google Scholar 

  30. Jones SC, Evans SW, Lobo AJ, Ceska M, Axon ATR, Whicher JT: Serum interleukin-8 in inflammatory bowel disease. J Gastroenterol Hepatol 8:508–512, 1993

    Google Scholar 

  31. Kucharzik T, Stoll R, Lugering N, Domschke W: Circulating antiinflammatory cytokine IL-10 in patients with inflammatory bowel disease. Clin Exp Immunol 100:452–456, 1995

    Google Scholar 

  32. Taub DD, Anver M, Oppenheim JJ, Longo DL, Murphy WJ: T lymphocyte recruitment by interleukin-8. J Clin Invest 97:1931–1941, 1996

    Google Scholar 

  33. Gilberts EC, Greenstein AJ, Katsel P, Harpaz N, Greenstein RJ: Molecular evidence for two forms of Crohn's disease. Proc Natl Acad Sci USA 91:12721–12724, 1994

    Google Scholar 

  34. Bhagat S, Das KM: A shared and unique peptide in the human colon, eye, and joint detected by a monoclonal antibody. Gastroente rology 107:103–108, 1994

    Google Scholar 

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Authors
  1. Marc Andre
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  2. Olivier Aumaitre
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  3. Thomas Papo
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  4. Jean-Louis Kemeny
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  5. Denis Vital-Durand
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  6. Hugues Rousset
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  7. Jacques Ninet
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  8. Philippe Pointud
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  9. Frederic Charlotte
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  10. Bertrand Godeau
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  11. Jeannot Schmidt
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  12. Jean-Claude Marcheix
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  13. Jean-Charles Piette
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Andre, M., Aumaitre, O., Papo, T. et al. Disseminated Aseptic Abscesses Associated with Crohn's Disease (A New Entity?). Dig Dis Sci 43, 420–428 (1998). https://doi.org/10.1023/A:1018835228850

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  • DOI: https://doi.org/10.1023/A:1018835228850

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