Pigmented purpuric dermatoses (PPDs) tend to vary clinically, yet share a similar histology. Granulomas are only rarely seen, with 4 prior reported cases, designated granulomatous pigmented purpura. Historically, granulomatous pigmented purpura has been seen in Asians. In this article, we report the case of a 42-year-old, white female with granulomatous pigmented purpura, the fifth such reported case in the literature. Histopathological examination revealed a granulomatous dermatitis with eosinophils, extravasated erythrocytes, melanophages, and vascular proliferation. These findings were consistently reported on subsequent biopsy 6 months later. This case illustrates a rare histological finding in PPDs. Medications associated with PPD are reviewed and the patient's use of mesalamine and balsalazide for ulcerative colitis are deemed potential triggers, given their relative similarity to aspirin, a known trigger of PPD. Although other granulomatous processes must be excluded in such patients, one must consider the possibility of granulomatous pigmented purpura in the appropriate setting.

Granulomatous pigmented purpura: an unusual histological variant.

It is estimated that almost half of patients affected with Crohn disease (CD) experience a dermatologic manifestation of the condition. Metastatic CD (MCD) is a rare dermatologic entity, with as few as 100 cases reported in the literature. As such, MCD presents a clinical dilemma in diagnosis and management. The etiology of MCD is not well defined; however, prevailing theories agree that the underlying mechanism is an immunologic response to gut antigens. Diagnosis requires a high index of suspicion and usually is made by exclusion of other processes. Treatment success has been reported with the use of antibiotics, immunosuppressants, and sometimes surgical treatment. We review the etiology/epidemiology, diagnostic criteria, and treatment of this uncommon condition.

Metastatic Crohn disease: a review of dermatologic manifestations and treatment.

/pdf/penile-crohn-s-disease-resolved-by-infliximab-vva5clf24e.pdf

Penile Crohn's disease resolved by infliximab

The metastatic Crohn’s disease involves granulomatous infiltration of skin in places anatomically separated fromthe gastrointestinal tract, with a tendency to chronicity. W e report the case of male patient, 20 years old, complaining of pain andelimination of purulent secretion from ulcers in the perianal region, right inguinal and genital for six months, without improvementusing metronidazole and ciprofloxacin. Previous proctocolectomy in 2002. On examination, the inspection revealed a fistulousorifice on posterior midline at 2.0 cm from the anal verge, an ulcer of 5.0 cm at the base of the scrotum and other ulcer encirclingthe base of the penis; on digital touch, anus fibrotic and incarcerated. Performed fistulotomy, biopsy and curettage of genital andinguinal ulcers. The histo-pathological study confirmed noncaseating granulomatous inflammatory process. Because of thefailure of antimicrobial therapy, it was opted for treatment infliximab at the dose 5 mg/kg at weeks 0, 2 and 6, and azathioprine2 mg/kg/day. In the end stage of induction, the patient had partial healing of ulcerated lesions, absence of secretion and painrelief. Currently in monitoring with outpatient infusions of infliximab every eight weeks.Key words: Crohn’ s disease; Metastatic; Skin; Perineum; Biologic therapy .

/pdf/uso-de-terapia-biologica-na-doenca-de-cr-ohn-metastatica-5fcjj7hg88.pdf

Uso de Terapia Biológica na Doença de Cr ohn Metastática: Relato de Caso e Revisão da Literatura Use of Biological Therapy in Metastatic Crohn's Disease: A Case Report and Literature Review

The metastatic Crohn's disease involves granulomatous infiltration of skin in places anatomically separated from the gastrointestinal tract, with a tendency to chronicity. We report the case of male patient, 20 years old, complaining of pain and elimination of purulent secretion from ulcers in the perianal region, right inguinal and genital for six months, without improvement using metronidazole and ciprofloxacin. Previous proctocolectomy in 2002. On examination, the inspection revealed a fistulous orifice on posterior midline at 2.0 cm from the anal verge, an ulcer of 5.0 cm at the base of the scrotum and other ulcer encircling the base of the penis; on digital touch, anus fibrotic and incarcerated. Performed fistulotomy, biopsy and curettage of genital and inguinal ulcers. The histo-pathological study confirmed noncaseating granulomatous inflammatory process. Because of the failure of antimicrobial therapy, it was opted for treatment infliximab at the dose 5 mg/kg at weeks 0, 2 and 6, and azathioprine 2 mg/kg/day. In the end stage of induction, the patient had partial healing of ulcerated lesions, absence of secretion and pain relief. Currently in monitoring with outpatient infusions of infliximab every eight weeks.

/pdf/uso-de-terapia-biologica-na-doenca-de-crohn-metastatica-l91lrjc9nx.pdf

Uso de terapia biológica na doença de Crohn metastática: relato de caso e revisão da literatura

Crohn's disease is a chronic granulomatous disorder, which may involve any segment of the gastrointestinal tract from the mouth to the anus. Although extraintestinal manifestations are frequent, involvement of skin distant to the gastrointestinal tract is uncommon. We report a case of Crohn's disease affecting penile and scrotal skin.

Metastatic crohn's disease--penile and scrotal involvement.

: The development of medical devices often depends on in vivo studies to validate the proper functioning of the products. These trials provide ethical as well as economic challenges, which can be partially addressed by the usage of realistic synthetic tissue models that replicate human anatomy and the corresponding properties of the biological tissue. In this work, a silicone-based model with a fiber structure and a PVA-based model that exhibits fabrication-induced anisotropy are presented in the special context of the lower urinary tract. The analysis of the materials in the uniaxial tensile test shows the anisotropic and viscoelastic properties of the materials. Furthermore, the anatomical model of the lower urinary tract shows expected deformation in simulation as well as in the real silicone model. Additionally, a suitable artificial urine according to ISO 20696 is shown for use with the model. First experiments to change the pH of the artificial urine are successfully conducted.

Towards a Synthetic Tissue Model of the Lower Urinary Tract

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Metastatic crohn's disease--penile and scrotal involvement.

Towards a Synthetic Tissue Model of the Lower Urinary Tract