Crohn's Disease Initially Accompanied by Deep Vein Thrombosis and Ulnar Neuropathy without Metronidazole Exposure

Kim, Woo Hyeon; Kang, Borami; Kim, Byung‐Wook; Kim, Joon Sung; Lee, Hae Mi; Lim, Eun Joo; Kim, Jong In; Kang, Bong Koo; Ji, Jeong‐Seon; Lee, Bo In; Choi, Hwang

doi:10.5009/gnl.2013.7.2.252

Cited by 2 publications

(1 citation statement)

References 13 publications

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“…In Korea, a few cases of thrombotic complications in patients with CD have been reported ( Table 1 ). 5 6 7 8 9 In cases of venous thrombosis, cerebral vascular involvement is very rarely observed. 4 5 Cerebral venous thrombosis can be accompanied by neurologic abnormalities caused by rapidly elevating intracranial pressure, and can result in serious adverse events.…”

Section: Discussionmentioning

confidence: 99%

Cerebral venous thrombosis in a patient with Crohn's disease

et al. 2016

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Patients with inflammatory bowel disease (IBD) have an elevated risk of venous thromboembolism compared with the general population. The most common sites of venous thromboembolism in IBD patients are the deep veins of the legs, the pulmonary system, and portal and mesenteric veins. However, cerebral venous thrombosis is rarely associated with IBD. This report describes a case of cerebral venous thrombosis in a patient with Crohn's disease. A 17-year-old girl, diagnosed 4 years earlier with Crohn's disease, presented with headache and vomiting. Magnetic resonance imaging of the brain with venography showed venous thrombosis in the cortical veins, superior sagittal sinus, right transverse sinus, and right internal jugular vein. The patient immediately started anticoagulation therapy with intravenous heparin infusion followed by daily oral rivaroxaban 10 mg. Follow-up imaging after 2 weeks showed resolution of the thrombosis, with recanalization of the cortical veins, superior sagittal sinus, right transverse sinus, and right internal jugular vein. She continued rivaroxaban therapy for 6 months, and remained well, without neurologic sequelae. A high level of concern for cerebral venous thrombosis may be important when treating active IBD patients, because anticoagulation treatment can prevent fatal complications.

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Section: Discussionmentioning

confidence: 99%

Cerebral venous thrombosis in a patient with Crohn's disease

et al. 2016

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Co-occurrence of oral pemphigus vulgaris and herpes simplex virus infection in a young patient with Crohn’s disease: report of a rare case of oral lesions during anti-TFN alpha and immunomodulator therapy

Lopes,

de Oliveira,

de Campos Augusto

et al. 2024

Int J Colorectal Dis

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Background Pemphigus vulgaris (PV) is a potentially life-threatening mucocutaneous autoimmune disease that affects desmoglein-1 and desmoglein-3, leading to intraepithelial vesiculobullous lesions. In the oral mucosa, PV lesions can mimic other diseases such as mucous membrane pemphigoid, other forms of pemphigus, recurrent aphthous stomatitis, erythema multiforme, Stevens-Johnson syndrome, and virus-induced ulcers like herpes simplex virus (HSV), making diagnosis challenging. The co-occurrence of PV with Crohn’s disease is rare and predominantly seen in younger patients. The therapeutic mainstay for both PV and Crohn’s disease usually involves systemic corticosteroids combined with immunosuppressants and immunobiological drugs. Literature indicates that the use of these drugs, particularly TNF-alpha inhibitors, for managing autoimmune diseases like Crohn’s can potentially induce other autoimmune diseases known as autoimmune-like syndromes, which include episodes of lupus-like syndrome and inflammatory neuropathies. There are few cases in the literature reporting the development of PV in individuals with CD undergoing infliximab therapy. Case report. A young female with severe Crohn’s disease, treated with the TNF-alpha inhibitor infliximab, developed friable pseudomembranous oral ulcerations. Histopathological and immunofluorescence analyses confirmed these as PV. The treatment included clobetasol propionate and low-level photobiomodulation, which resulted in partial improvement. The patient later experienced severe intestinal bleeding, requiring intravenous hydrocortisone therapy, which improved both her systemic condition and oral lesions. Weeks later, new ulcerations caused by herpes virus and candidiasis were identified, leading to treatment with oral acyclovir, a 21-day regimen of oral nystatin rinse, and photodynamic therapy, ultimately healing the oral infections. To manage her condition, the gastroenterologists included methotrexate (25 mg) in her regimen to reduce the immunogenicity of infliximab and minimize corticosteroid use, as the patient was in remission for Crohn’s disease, and the oral PV lesions were under control. Conclusion Young patients with Crohn’s disease should be referred to an oral medicine specialist for comorbidity investigation, as oral PV and opportunistic infections can arise during immunosuppressive therapy. The use of TNF-alpha inhibitors in patients treated for inflammatory bowel disease, such as Crohn’s, should be carefully evaluated for potential side effects, including oral PV.

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Crohn's Disease Initially Accompanied by Deep Vein Thrombosis and Ulnar Neuropathy without Metronidazole Exposure

Cited by 2 publications

References 13 publications

Cerebral venous thrombosis in a patient with Crohn's disease

Cerebral venous thrombosis in a patient with Crohn's disease

Co-occurrence of oral pemphigus vulgaris and herpes simplex virus infection in a young patient with Crohn’s disease: report of a rare case of oral lesions during anti-TFN alpha and immunomodulator therapy

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