1/35. Erosive polyarthritis in Crohn's disease. Report of a case.Erosive polyarthritis in Crohn's disease is rare and raises diagnostic and pathophysiological problems. A case with destructive lesions of the shoulders and hips is reported in a 43-year-old woman with a 26-year history of Crohn's disease. ankylosis of the spine and hips, motion range limitation of the shoulders and wrists, and boutonniere deformity of the third finger of the right hand were present. Tests were negative for rheumatoid factor and the hla-b27 antigen. Plain radiographs showed a triple rail pattern at the spine; synostosis of the hips; and destructive lesions of the shoulders, wrists, tarsal bones, and third proximal interphalangeal joint of the right hand. Glucocorticoid therapy was effective in suppressing the bowel symptom flares but only partially improved the joint symptoms, whose treatment relied mainly on nonsteroidal antiinflammatory agents and rehabilitation therapy. Erosive arthritis in Crohn's disease is frequently monoarticular, with the hip being the most common target. It can complicate a spondylarthropathy or reveal granulomatous synovitis. Polyarticular forms pose difficult diagnostic and therapeutic challenges and add to the disability caused by the bowel disease. The potential role of genetic factors remains to be studied.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/35. gastric outlet obstruction and pulmonary infiltrate in a patient with Crohn's disease: successful treatment by Billroth-II-resection.We present a 28-year-old women with a 3 yr history of duodenal ulcers. Following four treatment attempts to eradicate helicobacter pylori she was admitted because of gastric outlet obstruction and a weight loss of 20 kg within the last two years. endoscopy and x-ray showed a circular inflammatory stenosis of the proximal duodenum extending over 8 cm. Additionally, chest x-ray showed a circumscript infiltrate in the third segment of the right lung. Mycobacterial infection could be excluded. Ileocolonoscopy and small intestinal follow-through beyond the duodenum were unremarkable, and Zollinger-Ellison-syndrome was ruled out. Bronchopulmonary histology showed intramucosal epithelioid-cell granulomas and bronchiolitis obliterans. Because the patient did not improve under conservative therapy a Billroth-II-resection was carried out. Histologically the resected specimen showed Crohn-like lesions. Postoperatively, severe peripheral arthritis was treated by steroids over 6 weeks. At follow-up the patient regained 20 kg and was free of symptoms without any medication. The pulmonary infiltrate had subsided almost completely. In summary, this extremely rare coincidence of isolated stenosing duodenal Crohn's disease and pulmonary involvement was successfully treated by Billroth-II-resection. This course of disease is compatible with the hypothesis that Crohn's disease may be maintained by antigens derived from ingested food.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/35. adenocarcinoma of the small intestine arising in Crohn's disease. Demonstration of a tumor-associated antigen in invasive and intraepithelial components.A segment of small intestine surgically removed from a man with intestinal obstruction was found to have coexisting regional enteritis and an invasive adenocarcinoma associated with an area of intraepithelial neoplasia. The cells of the adenocarcinoma and the intraepithelial neoplasia contained a tumor-associated surface antigen capable of reacting with an antiserum prepared against a colonic carcinoma. The importance of thorough sampling of specimens of regional enteritis in accurate reporting of the incidence of carcinoma is stressed, as is the use of immunohistologic techniques as an adjunct to the morphologic diagnosis of preinvasive neoplasia.- - - - - - - - - - ranking = 5keywords = antigen (Clic here for more details about this article) |
4/35. Anti-glomerular basement membrane nephritis and bullous pemphigoid caused by distinct anti-alpha 3(IV)NC1 and anti-BP180 antibodies in a patient with Crohn's disease.BACKGROUND: Anti-glomerular basement membrane (GBM) nephritis is a rare disease induced by antibodies directed against alpha3(IV)NC1, the Goodpasture antigen. We report a patient with Crohn's disease who developed anti-GBM nephritis and the skin blistering disorder bullous pemphigoid, owing to distinct autoantibodies. methods: frozen sections of skin and kidney biopsies were incubated with antisera specific for human IgG, IgA, IgM, fibrin, and C3. Reactivity of the patient's serum with GBM antigens was studied by Western blot using bovine solubilized type IV collagen and by enzyme-linked immunosorbent assays using alpha1(IV), alpha3(IV), and alpha5(IV)NC1 recombinant proteins. Reactivity studies against skin antigens were done by Western blot using human keratinocyte and dermal extracts and three recombinant forms of the bullous pemphigoid antigen180 (BP180, also called BPAG2 or type XVII collagen). The patient's serum was affinity fractionated on a (IV)NC1 column, and the bound and unbound fractions were analyzed for their reactivity against GBM and skin antigens. RESULTS: The patient had deposits of IgG along the GBM and the epidermal basement membrane zone. Circulating IgG antibodies against alpha3(IV)NC1 were detected. The patient's autoantibodies immunoblotted the intracellular domain but not the extracellular domain of BP180. Reactivity of the patient's IgG with BP180 was found only in the unbound fraction of the serum. CONCLUSION: The simultaneous development of a rare renal and skin autoimmune disorder, resulting from non-cross-reactive autoantibodies, suggests that a common triggering event could be responsible for the autoimmune injury.- - - - - - - - - - ranking = 5keywords = antigen (Clic here for more details about this article) |
5/35. factor xiii and tissue transglutaminase antibodies in coeliac and inflammatory bowel disease.Tissue transglutaminase (tTg) has been identified as an autoantigen in coeliac disease (CD). There is a marked homology between different forms of transglutaminase, such as tTg and coagulation factor xiii. We compared titres of both IgA- and IgG-antibodies against these two antigens in 20 CD patients, 20 endomysial antibody (EMA)-negative controls and a group with inflammatory bowel disease (34 with Crohn's disease and 23 with ulcerative colitis). IgA-antibodies against tTg correlated with EMA titres and had high sensitivity and specificity in screening for CD. Only in two CD patients were high titres found of IgA-antibodies against factor xiii, non-reactive with tTg. Both lacked bleeding tendency. The presence of IgG-antibodies against tTg, in contrast, had low sensitivity and specificity in screening for CD and were frequently seen in inflammatory bowel disease. Similarly, factor xiii IgG-antibodies displayed a non-specific pattern with modestly elevated titres in patients with Crohn's disease and in both EMA-negative and positive patients. Despite a marked homology with tTg, the occurrence of high titre IgA-antibodies against factor xiii is infrequent in CD, but may-when present-be the result of epitope spreading. The presence of IgG-antibodies in CD and inflammatory bowel disease illustrates the complexity of autoantibody reactions in gastrointestinal disease.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
6/35. Recurrent myopericarditis in association with Crohn's disease.Myopericarditis is a rare extraintestinal complication of inflammatory bowel disease (IBD). It has also been described as a side-effect of the treatment of IBD. We report a 37-year-old-woman with Crohn's disease who had several mild episodes of myopericarditis, two of which were associated with a pleural effusion, and two with conduction abnormalities in the atrioventricular node. During the last episode, a nodal rhythm was followed by a third-degree atrioventricular block and a prolonged pause, resulting in loss of consciousness and convulsions. A permanent pacemaker was implanted. Our patient is also human lymphocyte antigen (HLA) B27-positive. HLA B27 is known to be associated with conduction disturbances in the AV node. Recurrent myopericarditis can be a sign of IBD.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/35. Inflammatory bowel disease in all three members of one family.The occurrence of inflammatory bowel disease in all three members of one family is described. Studies of white blood cell chromosomes, histocompatibility antigens, and cellular and humoral immunity failed to explain this unusual phenomenon. However, the appearance of inflammatory bowel disease in an entire family reemphasizes the potential role of genetic and environmental influences in the pathogenesis of some cases of ulcerative colitis and Crohn's disease.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
8/35. Crohn's disease associated with diffuse lymphoid hyperplasia of the large intestine: a possible role of the lymph follicle in HLA-DR antigen expression on epithelium.A 14-year-old girl diagnosed as Crohn's disease had lymphoid hyperplasia throughout the large bowel. biopsy specimens from the lymphoid hyperplasia demonstrated non-caseous granulomas within the lymph follicles. An immuno-histochemical study of biopsy specimens showed that hla-dr antigens were expressed on epithelium close to the lymph follicle, which was observed in all specimens containing the lymph follicle. This case provides evidence for the importance of the lymph follicle in the etiopathogenesis of Crohn's disease by demonstration of non-caseous granulomas within the lymph follicle and expression of hla-dr antigens on epithelium close to the lymph follicle.- - - - - - - - - - ranking = 6keywords = antigen (Clic here for more details about this article) |
9/35. Infliximab-induced lupus in Crohn's disease: a case report.An 18-year-old male patient was under treatment with infliximab at a dose of 5 mg/kg at Weeks 0, 2 and 6 for refractory Crohn's disease. In June 2002, the patient was admitted to the Outpatient Clinic of the rheumatology Unit for arthralgia affecting the small joints, non-pruritic crops of purple skin lesions and malar rash in the face. serum antinuclear antibodies were positive (1:640 speckled pattern), and anti-double-stranded dna was positive (1:80); moreover, positivity of anti-extractable nuclear antigen was observed. Antihistone antibodies, lupus anticoagulant and anticardiolipin antibodies were negative. A diagnosis of infliximab-induced lupus was made and the drug treatment was withdrawn. However, 3 months after withdrawal of treatment, the patient still showed clinical and laboratory symptoms of systemic lupus erythematosus. After 6 months of treatment, systemic lupus erythematosus-related symptoms disappeared and anti-double-stranded dna returned to normal. The patient is currently under treatment with prednisone 20 mg/day for systemic lupus erythematosus and with oral mesalazine 2.4 mg/day for Crohn's disease. Treatment with infliximab is known to produce an increase of autoantibodies (antinuclear antibodies, anti-double-stranded dna), but not clinical disease. This is the first case, to our knowledge, of onset of prolonged infliximab-induced lupus.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/35. Crohn's disease recurrence in a small bowel transplant.This is a report of a patient with short-bowel syndrome secondary to recurrent surgeries for Crohn's disease who ultimately required small bowel transplantation in 1994. Eight years posttransplantation he developed recurrent Crohn's disease that was responsive to prednisone. From the perspective of advancing our understanding of Crohn's disease pathogenesis this case suggests that intestine-specific antigens may be more important than the classical MHC antigens for the development of Crohn's disease, since this man developed Crohn's disease in both the native intestine and also in the engrafted one.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
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