Guerre-Schmidt A-R, Pelletier F, Carbonnel F, Humbert P, Aubin F
Département de dermatologie, CHU Saint-Jacques, 2, place Saint-Jacques, 25030 Besancon cedex, France.
Rev Med Interne. 2006 Nov;27(11):874-7. doi: 10.1016/j.revmed.2006.07.017. Epub 2006 Aug 18.
Pustulosis, erythema nodosum, arthritis and systemic manifestations are associated in the dermatosis-arthritis syndrome. It is a well recognized complication of the bowel ileo-jejunal bypass but it is also associated with inflammatory bowel diseases.
We report the case of an adolescent who presented with a dermatosis-arthritis syndrome associated to a Crohn's disease during a referring for pustulosis, erythema nodosum and fever. The evolution is complicated by proctorragia. Colonoscopy and intestinal biopsy found a Crohn's disease. Cutaneous and intestinal symptoms quickly improved with systemic corticosteroids.
The dermatosis-arthritis syndrome can be associated with bowel bypass and with inflammatory bowel disease, more frequently with ulcerative colitis than with Crohn's disease. It consists in a vesiculo-pustular eruption, erythema nodosum, fever, arthritis and ocular manifestations. Histopathology bears a strong resemblance with Sweet's syndrome. Physiopathology implicates microbial proliferation, formation of immune complex against skin and activation and migration of neutrophils and increasing factors. The treatment is based on corticosteroids and non steroid anti-inflammatory drugs or dapsone.
脓疱病、结节性红斑、关节炎和全身表现与皮肤病-关节炎综合征相关。它是回肠-空肠旁路手术公认的并发症，但也与炎症性肠病有关。
我们报告一例青少年患者，因脓疱病、结节性红斑和发热就诊时出现与克罗恩病相关的皮肤病-关节炎综合征。病情因直肠出血而复杂化。结肠镜检查和肠道活检发现为克罗恩病。全身使用皮质类固醇后皮肤和肠道症状迅速改善。
皮肤病-关节炎综合征可与肠道旁路手术及炎症性肠病相关，与溃疡性结肠炎的关联比与克罗恩病更为常见。它表现为水疱脓疱性皮疹、结节性红斑、发热、关节炎和眼部表现。组织病理学与斯威特综合征极为相似。病理生理学涉及微生物增殖、针对皮肤的免疫复合物形成以及中性粒细胞的激活、迁移和增加因子。治疗基于皮质类固醇、非甾体抗炎药或氨苯砜。
