Nodular Vasculitis in a Patient With Crohn's Disease on Vedolizumab

Abstract

Erythema induratum (EI), or nodular vasculitis (NV), is a type of panniculitis that is often associated with vasculitis affecting various-sized veins, venules, and arteries in reaction to various causative factors. Historically, EI was highly linked to tuberculosis, but in 1946, Montgomery first proposed the term NV to describe cases of EI not associated with tuberculosis. Only 2 reports of NV associated with inflammatory bowel disease have been reported in the literature. The authors report a 60-year-old woman with Crohn's disease presenting with exacerbation of NV in the setting of vedolizumab therapy.

Dermatological changes associated with non-specific inflammatory bowel diseases – Crohn’s disease and ulcerative colitis

“…Due to its selective action on the intestinal vascular epithelium, this drug is considered very safe. There are reports of exacerbation of skin lesions in the course of pyoderma gangrenosum and nodular vasculitis occurring after switching to vedolizumab, which probably results from insufficient drug efficacy in the treatment of extraintestinal manifestations [68,78]. A case of Sweet's syndrome has also been reported, the symptoms of which appeared 24 hours after the first dose of vedolizumab [79].…”

“…Ze względu na selektywne działanie na nabłonek naczyń jelit lek ten uważany jest za bardzo bezpieczny. W piśmiennictwie przedstawiono opisy przypadków zaostrzenia zmian skórnych w przebiegu piodermii zgorzelinowej oraz guzkowego zapalenia naczyń po zmianie terapii na wedolizumab, co prawdopodobnie wynika z jego niewystarczającej skuteczności w leczeniu manifestacji pozajelitowych [68,78]. Opisano także przypadek zespołu Sweeta, którego objawy pojawiły się po 24 godzinach od podania pierwszej dawki wedolizumabu [79].…”

Common traps/pitfalls and emergency diagnosis in dermatopathology

“…There are granulomas with macrophages and multinucleated giant cells. Frank vasculitis and zones of fat necrosis are more common in erythema induratum, a lobular panniculitis associated with tuberculosis although some cases have been reported in patients receiving targeted therapies [21].…”

A Unique Infusion Reaction to Vedolizumab in a Patient With Crohn’s Disease

“…This particular paradoxical cutaneous inflammatory effect has been reported in 2 patients with Crohn's disease treated with vedolizumab, with one developing nodular vasculitis and the other developing pyoderma gangrensoum. 2,3 Given that HSP in adults has been associated with significant morbidity from possible long-term end-stage renal disease, identifying this condition early is crucial. Physicians who infuse vedolizumab should be aware of HSP as a possible infusion reaction, especially in patients who develop a lower extremity rash in the immediate postinfusion period.…”