Leukocytoclastic Vasculitis as an Extraintestinal Manifestation of Crohn’s Disease

Abstract

Cutaneous involvement is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). More commonly, pyoderma gangrenosum and erythema nodosum are noted, but psoriasis, aphthous stomatitis, Sweet’s syndrome, and vasculitis may also occur. Leukocytoclastic vasculitis (LCV) is a rare cutaneous manifestation, characterized by the appearance of palpable purpura, urticaria, and ulcer-necrotic lesions predominantly in the lower extremities that improve with immunosuppressive therapy. In this case, we report a patient with CD and LCV. We also searched the literature on the diagnosis and treatment of LCV in patients with CD. Female, 31, presented with diarrhea containing mucus and blood, abdominal pain, arthralgia, and enanthematous plaques and ulcers with a hematinic background in the lower extremities. The results of the colonoscopy were compatible with CD and skin biopsy showed signs of LCV. Systemic autoimmune disease and primary vasculitis were ruled out. The patient received treatment with a systemic corticosteroid and the skin lesions improved. Outpatient treatment with antitumor necrosis factor therapy was initiated to promote skin healing and IBD clinical remission. As LCV is a rare manifestation of IBD, it is necessary to distinguish this dermatopathy from other systemic vasculitis. The engagement of a multidisciplinary team is essential for the correct diagnosis and management.

Leukocytoclastic Vasculitis Secondary to Anti-Tumor Necrosis Factor Therapy in Inflammatory Bowel Diseases: A Multicenter Retrospective Cohort Study

“…Although cutaneous vasculitis may be an uncommon extraintestinal manifestation of IBD, especially CD, this condition is typically reported at the onset of symptoms or during periods of disease activity. In our case series, all the patients were in deep remission (i.e., endoscopic and clinical remission) at the time of their LCV diagnosis [27]. Additionally, the complete remission of skin lesions occurred a mean of eight weeks after the withdrawal of the anti-TNF therapy and the initiation of systemic steroids.…”

Leukocytoclastic Vasculitis and Myositis as Initial Manifestations of Crohn’s Disease

“…LCV is a rare disease, and its prevalence in patients with Crohn’s disease has not been extensively researched. It can occur as the initial presentation of Crohn’s disease, as seen in our patient, and can occur during disease flare [ 17 - 19 ].…”