Burns Ariel M, Walsh Noreen, Green Peter J
Dalhousie University, Halifax, NS, Canada.
J Cutan Pathol. 2010 Oct;37(10):1077-83. doi: 10.1111/j.1600-0560.2010.01546.x. Epub 2010 Apr 26.
Cutaneous complications occur not uncommonly in patients with Crohn's disease (CD). Gastrointestinal CD often shows non-caseating granulomas and a rare cutaneous finding in CD is a sterile granulomatous infiltrate not contiguous with the GI tract, termed extraintestinal CD (ECD). The clinical presentation of ECD is diverse. The most common histopathological presentation is a superficial and deep granulomatous infiltrate that often accompanies a mixed perivascular infiltrate. Here we report two patients with CD and skin lesions characterized on microscopy by granulomatous vasculitis. A 29-year-old female presented with papules and ulcerated nodules above the ankle. The biopsy showed dermal and superficial subcutaneous involvement by a vasocentric infiltrate of mononuclear and multinucleated histiocytes as well as mural fibrin deposition. A 35-year-old male presented with two tender indurated erythematous plaques with punched-out centers on the lower leg. Histopathologically, a granulomatous vasculitis of small and medium-sized vessels in the dermis and subcutis was evident. These two cases represent the rarely described phenomenon of cutaneous granulomatous vasculitis in CD. Previously reported examples of this entity are reviewed.
皮肤并发症在克罗恩病（CD）患者中并不罕见。胃肠道CD常表现为非干酪样肉芽肿，而CD中一种罕见的皮肤表现是与胃肠道不连续的无菌性肉芽肿浸润，称为肠外CD（ECD）。ECD的临床表现多样。最常见的组织病理学表现是浅表和深部肉芽肿浸润，常伴有混合性血管周围浸润。在此，我们报告两名患有CD且皮肤病变在显微镜下表现为肉芽肿性血管炎的患者。一名29岁女性患者，踝关节上方出现丘疹和溃疡结节。活检显示真皮和浅表皮下组织有以血管为中心的单核和多核组织细胞浸润以及壁内纤维蛋白沉积。一名35岁男性患者，小腿出现两个有 punched-out 中心的压痛性硬结红斑斑块。组织病理学上，真皮和皮下组织中小血管和中等大小血管的肉芽肿性血管炎明显。这两例代表了CD中罕见描述的皮肤肉芽肿性血管炎现象。对该实体先前报道的病例进行了综述。
