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- Title
WHEN DERMATOLOGY MEETS GASTROENTEROLOGY OR AN UNCOMMON ASSOCIATION IN DAILY PRACTICE OF CLASSIC AUTOIMMUNE DISEASES.
- Authors
Guluță, Elena-Cristina; Negreanu, Lucian; Benamouzig, Robert; Sabate, Jean-Marc; Hammami, Sirine; Liu, Guillaume; Rekab, Rima; Babiuc, Ruxandra-Doina; Călinoiu, Amalia-Loredana
- Abstract
Introduction. Hidradenitis suppurativa (HS) or Verneuil's disease is a chronic inflammatory skin disease characterised by recurrent inflammatory nodule, tombstone comedones and abscess formation. Starting from 1993 when Church et al. reported the presence of Crohn Disease in 38% of the patients with hidradenitis suppurativa, multiple studies have described the association between HS and inflammatory bowel diseases. The most recent data in the literature proves a stronger correlation between Crohn Disease and HS (HR=2.25; 95% CI 1.52-3.32) than between ulcerative colitis and HS (HR=1.56; 95% CI 1.26-1.94). Despite this, the association of the two conditions is still uncommon in the daily practice, leading to multiple challenges regarding the management of these patients. Case report. A 25 year old smoking patient was admitted in our department for abdominal pain and approximately 12 glero sanguineous diarrheal stools per day accompanied by anal incontinence. The medical history reveals an ulcerative colitis firstly diagnosed in 2019 and Verneuil's disease from 2020. After a first therapeutic failure at Mesalazine and multiple surgical interventions to drain perineal abscesses in 2019, a combotherapy by Azathioprine and Adalimumab was started in 2020, as well as a treatment by Doxycycline for Verneuil's disease. The patient was lost of view for one year, stopping her treatment against medical advice. A medication by Infliximab was restarted one year later, but during the second perfusion, the female presented a severe reaction with abdominal pain and vomiting. Consequently, a new treatment line by Ustekinumab and Methotrexate was initiated but she stopped it one more time claiming for total colectomy. During the present hospitalisation, a rectosigmoidoscopy was performed, the progression up to the 25 cm from the anal margin showing an active ulcerative colitis classified UCEIS 6 out of 8. Despite the patient's desire for colectomy, a last medical attempt by Filgotinib was initiated. Discussion. The most recent French guidelines regarding HS recommend a treatment based on Adalimumab or Infliximab in case of the forms associated to inflammatory bowel diseases. However, there are not standardized protocols in case of therapeutic resistance or intolerance to anti-TNF medication. Conclusion. Our case underlines the challenging therapeutic management in a case of a depressive young patient with an uncommon association of autoimmune diseases and emphasize the need of new future perspectives concerning the association between Verneuil's disease and inflammatory bowel diseases, especially in the light of the increasing incidence of the last ones.
- Subjects
INFLAMMATORY bowel diseases; CROHN'S disease; ULCERATIVE colitis; AUTOIMMUNE diseases; DERMATOLOGY; HIDRADENITIS suppurativa
- Publication
Journal of Gastrointestinal & Liver Diseases, 2023, Vol 32, p95
- ISSN
1841-8724
- Publication type
Article