Aseptic Abscesses and Inflammatory Bowel Disease: Two Cases and Review of Literature

Abstract

Background. Aseptic abscesses (AA) are sterile lesions that represent an extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD). Though Canada has the highest prevalence of IBD in the world, reports of IBD-associated AA are absent in Canada. This may represent a different IBD phenotype or underrecognition and underreporting. Purpose. To explore AA as a possible EIM of IBD and evaluate clinical and investigative findings among patients with IBD-associated AA. Methods. Retrospective chart and literature reviews were performed to find cases of IBD-associated AA at our institution and in the literature. Results. We identified 2 cases of IBD-associated AA in our institution. Both patients had ulcerative colitis and presented with fever, abdominal pain, and weight loss. Radiological workup and aspiration showed sterile splenic abscesses. The AA were unresponsive to antibiotics. One patient improved on corticosteroids and one underwent splenectomy. We retrieved 37 cases of IBD-associated AA from the literature. All patients showed no evidence of infection, failed to resolve with antibiotics, and, if attempted, improved on corticosteroids. Conclusions. Our cases are the first reported in Canada. They support literature which suggests AA as an EIM of IBD and may help increase recognition and reporting of this phenomenon.

Saddle Nose Deformity as a Result of an Aseptic Nasal Abscess Accompanied by Ulcerative Colitis and Pyoderma Gangrenosum

“…Lastly, occurrence of prompt clinical improvement on corticosteroid therapy with or without additional immunosuppressant therapy and subsequent radiologic evidence of abscess resolution. 7) In the present case, the causal relationship between ulcerative colitis and intranasal symptoms could not be confirmed by histological examination. However, in light of the fact that the bacterial culture of the nasal septum was negative and the deterioration of symptoms resolved after the immunosuppressive treatment, we believe aseptic abscess in the septal cartilage caused nasal septal necrosis, which eventually led to the saddle nose deformity in this patient.…”

Aseptic abscess syndrome

“…It is important to consider colonoscopy when previously healthy patients are diagnosed with AAS given that it can be the initial manifestation of IBD. 2 3 5 The pathophysiology of AAS is not clearly understood. The characteristic pathological finding of sterile neutrophilic infiltration of the deep tissues is similar to that of the neutrophilic dermatoses, which is characterised by sterile neutrophilic infiltration of the skin.…”

“…In patients placed on steroid maintenance therapy alone relapse occurred in some, but not all patients. 2 Disease-modifying antirheumatic drugs (DMARDs) and biological targeted agents have been used as maintenance therapy. DMARDs that have been used to treat AAS include azathioprine, colchicine, cyclophosphamide, ciclosporin, methotrexate and mycophenolate mofetil.…”

“… 1 Most patients respond favourably to high-dose immunosuppression and achieve long-term remission with steroid-sparing agents. 2 3 The key is establishing the diagnosis and starting immunosuppressive medications, which may initially appear to be a risky approach in a patient with the symptoms and signs of infection.…”

Aseptic Abscess Syndrome with Severe Skin Involvement: Case Report

“…Aseptic abscess syndrome is a disorder included in the group of neutrophilic diseases. [ 1 4 5 ] The diagnosis is established by excluding other diseases in a differential diagnosis. [ 3 ] Our case had a liver abscess for 4 years, and his general condition rapidly deteriorated when he also developed an abscess in the spleen, and then he developed cutaneous abscesses.…”