Severe case of Crohn’s disease with extraintestinal joint manifestation and psoriasis


Authors: J. Hurňáková 1,2;  P. Drastich 3;  M. Sedláčková 4;  R. Horváth 1,5;  L. Petrů 1,2;  K. Grobelná 1,2;  J. Gatterová 1;  K. Pavelka 1,2
Authors‘ workplace: Revmatologický ústav, Praha 1;  1. lékařská fakulta, Univerzita Karlova, Praha 2;  Institut klinické a experimentální medicíny, Praha 3;  Fakultní Thomayerova nemocnice, Praha 4;  Fakultní nemocnice Motol, Praha 5
Published in: Čes. Revmatol., 24, 2016, No. 2, p. 47-52.
Category: Case Report

Overview

Authors describe a case report of 70 years old female patient with autoimmune disease affecting skin, gastrointestinal, and musculoskeletal systems and present here a variable organ involvement that may occur in patients with spondyloarthropathies.

Initially, our patient presented only with mild psoriatic skin lesions. Afterwards, arthritis of wrist and left knee appeared that raised a suspicion on diagnosis of psoriatic arthritis. Later on, bloody stools along with fevers, weight loss and anemization occurred and she was diagnosed with idiopathic bowel disease – Cohn’s disease. Subsequently, gastrointestinal manifestation was dominant along the whole course of the disease. Despite intensive treatment, including biologic agents (TNFα blockers), she had repeatedly very severe systemic manifestations with septic complications and several acute surgery interventions. Terminal ileostomy was performed as the final surgery solution in our patient.

In the last years, rheumatic manifestations characterized by tendinopathy of Achilles tendons along with arthritis of knee joints appeared, and enteropathic arthritis with psoriasis was diagnosed in HLAB27 positive patient.

A case report presented here aimed to demonstrate that patients suffering from spondyloarthropathies may have a variable organ involvement with a variable disease course and may be treatment refractory despite of very intensive interventions. As spondyloarthropathies are group of distinct diseases with a common genetic predisposition and similar clinical features, recognition of their pathogenic pathways could aid to search for new therapeutical improvements.

Key words:
Psoriasis, Crohn’s disease, arthritis, HLA B-27, biologic therapy, spondyloartritis


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Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
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