Acute pustulosis of the legs in diverticulitis with sigmoid stenosis: an overlap between bowel‐associated dermatosis–arthritis syndrome and pustular pyoderma gangrenosum

Abstract

Although clinical and histological features in our case fit the diagnosis of bowel-associated dermatosis-arthritis syndrome, they may also correspond to a pustular variant of pyoderma gangrenosum. Our observation raises the question of the nosological classification of bowel-associated dermatosis-arthritis syndrome within the spectrum of neutrophilic diseases.

Pyoderma Gangrenosum, Acne and Suppurative Hidradenitis Syndrome following Bowel Bypass Surgery

“…The skin lesions are usually described as PG-like, but features mimicking those of several other neutrophilic dermatoses, notably Sweet’s syndrome, SH and neutrophilic panniculitis, have been reported [8,11,12]. Although bowel-associated dermatitis arthritis syndrome has been suggested to result from the deposition of circulating immune complexes containing bacterial antigens related to the bacterial overgrowth in the bowel [12], its actual etiology remains unknown. However, the substantial clinical overlap with the spectrum of neutrophilic dermatoses strongly suggests a pathophysiology related to neutrophil-mediated inflammation for this condition.…”

“…This disorder is characterized by recurrent fever, polyarthralgia/polyarthritis, myalgia, tenosynovitis and protean cutaneous manifestations [11]. The skin lesions are usually described as PG-like, but features mimicking those of several other neutrophilic dermatoses, notably Sweet’s syndrome, SH and neutrophilic panniculitis, have been reported [8,11,12]. Although bowel-associated dermatitis arthritis syndrome has been suggested to result from the deposition of circulating immune complexes containing bacterial antigens related to the bacterial overgrowth in the bowel [12], its actual etiology remains unknown.…”

Jejunoileal bypass as the main procedure in the onset of immune-related conditions: the model of BADAS

“…Patients with BADAS may benefit from treatment with systemic corticosteroids, cyclosporine or other drugs affecting the function of neutrophils, such as colchicine, sulphones or sulfasalazine, similar to those patients with neutrophilic disorders [12]. A novel therapeutic option might be the use of antibodies against TNF, which affects the recruitment of neutrophils in the skin [12].…”

“…A novel therapeutic option might be the use of antibodies against TNF, which affects the recruitment of neutrophils in the skin [12].…”

“…In fact, BBS has also been observed in association with the small stomach and Roux-en-Y jejunectomy, jejunocolic bypass [7], ileocolic bypass [8], ileoanal pouch anasto mosis [9], biliopancreatic diversion [10], in patients with gastric phytobezoar [11], diverticulitis with sigmoid stenosis [12], appendicectomy [13], Billroth II gastrectomy, Crohn's disease and ulcerative colitis without history of bowel surgery [8].…”