122 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0281 Gastroenterology
A Rare Case of Sweet’s Syndrome with Parotitis Com- plicated by Ileal Bleeding
Michito SADOHARA1, Reona WADA1, Kyoko NANAO1, Keisuke HATAMOTO1, Taku MAEJIMA2, Kazuo NAGAHIMA3
General Medicine, Sapporo Higashi Tokushukai Hospital, Japan1, Surgery, Sapporo Higashi Tokushukai Hospital, Japan2, Pathology, Sapporo Higashi Tokushukai Hospital, Japan3
An 84-year-old woman presented with a tender swelling of both her cheeks eight days prior to admission. She was initially treated with Clarithromycin. However, she developed generalized erythematous papules. On admission, parotitis and impetigo were suspected and Ceftriaxone was administered. Skin biopsy revealed perivenular histiocytic infi ltration without vasculitis. The histology along with the clinical fi ndings were compatible with the diagnosis of Sweet’s syndrome. She developed hematoche- zia between the fi fth and eighth hospitalization day. Enteroendoscopy revealed bleed- ing from the ileum. Bleeding was controlled by combination of endoscopic hemostasis by clipping and angiographic intervention using coil embolization. As the ileal bleeding was controlled and there was gradual clinical and laboratory improvement, corti- costeroids were not used. Ceftriaxone was changed to minocycline. The patient was fi nally discharged 42 days after her admission once she recovered from her symptoms.
After discharge, however she developed stricture of the ileum as a complication of an- giographic embolization. She subsequently underwent surgical resection of the ileum.
The resected ileum revealed ulceration and fi brinous changes compatible with angio- graphic embolization. However there were some histological changes that seemed to establish an association with Sweet’s syndrome. Sweet’s syndrome is characterized by constellation of clinical symptoms, physical features, and pathologic fi ndings that include fever, neutrophilia, tender erythematous skin lesions, and a diffuse infi ltrate of mature neutrophils.We report a rare case of Sweet’s syndrome with parotitis compli- cated by ileal bleeding without other underlying diseases.
PS 0282 Gastroenterology
Oral Manifestation of Crohn’s Disease – Case Report
Joao Gomes PEREIRA1, Rita Azenha CARDOSO2
C. Hosp. Lisboa Norte - Hospital De Santa Maria, Portugal1, Instituto Português de Oncologia Francisco Gentil, Portugal2
Inflammatory bowel diseases, such as Crohn’s, affect both the intestinal tract and extra-intestinal structures, such as within the oral cavity. Examination of the oral cavity my reveal fi ndings of underlying systemic condition, and thus allow early diag- nosis and treatment. Crohn’s Disease most common fi ndings include oral ulceration, indurated tag-like lesions, diffuse mucosal swelling, cobblestone mucosa, and localized mucogingivitis. This case report refers to a 41 year old female who presented fi ssures of the oral mucosa in the edentoulos region of the lower left fi rst molar, where she had previous extracted a tooth, several years before. Panoramic x-ray excluded osse- ous involvement. Since she he had a known diagnosis of Crohn’s disease, the lesions were interpreted as an oral manifestation and were kept in tight surveillance, every 3 months. Recently the lesions evolved to a more hyperplasic form, causing discomfort to the pacient, and were subsequently excised. The treatment of oral manifestations usually involves managing the underlying disease, but in severe cases topical and/or systemic steroids and imunossupressors can be used.
PS 0283 Gastroenterology
Age at Diagnosis and Clinical Characteristics of Crohn’s Disease in Korea
Jihye KIM1, Jong Pil IM1, Sung Wook HWANG1, Jaeyoung CHUN1, Changhyun LEE1, Joo Sung KIM1
Seoul National University College of Medicine, Korea1
Background: The late-onset Crohn’s disease (CD) may have distinctive characteristics, but they have not been established in Korea. The aim of the present study was to describe the clinical characteristics and treatment of CD patients according to age at diagnosis in a single-center.
Methods: A total of 236 patients diagnosed as CD at Seoul National University Hos- pital between 2004 and 2013 were included retrospectively in the present study. Age at diagnosis was categorized as <17, 17-40, 41-60 and > 60 years old. The baseline demographics, location, behavior, perianal disease, and the use of immunomodulators and anti-TNF á agents were analyzed.
Results: The number of CD patients according to age at diagnosis was 63 (26.7%), 137 (58.1%), 27 (11.4%), and 9 (3.8%), respectively. Older patients showed a higher frequency of ileal location (14.3%, 29.9%, 44.4%, and 33.3%), whereas younger patients showed a higher frequency of ileocolonic location (50.8%, 43.8%, 18.5%, and 33.3%) (P = 0.037). The behavior of CD and the Upper GI involvement rate did not signifi cantly differ between the age groups. Perianal disease was less frequently observed in older patients (25.8%, 13.6%, 3.7%, 0.0%) (P =0.019). As age at diagnosis increased, the use of immunomodulators and anti-TNF á agents decreased (P < 0.01).
Conclusions: The clinical characteristics of older CD patients were different from younger patients in the gender distribution, the disease location, the occurrence of perianal lesion and the use of immunomodulators and anti-TNF á agents. The results indicated the distinctive characteristics and treatment in older CD patients in Korea.
