Review Article

Aseptic Abscesses and Inflammatory Bowel Disease: Two Cases and Review of Literature

Table 1

Summary of IBD associated AA cases from the literature database and our search at St. Michael’s Hospital.

Study/patient IDAge/sexIBD phenotype (CD/UC/IC)Age of IBD diagnosis/temporal relation to diagnosis of AAIBD flare during AA SymptomsLocation of AAOther IBD EIMAntibiotic treatment Corticosteroids Additional immunotherapySurgical proceduresMaintenance therapy after diagnosis of AANumber of relapses

André et al. 2007 [5]/1–21Mean 24.4 (range 10–54)/12 F & 9 M17CD, 3UC, 1ICAverage age of IBD onset = 23.7 (range 12–38)/before (), concomitant (), after ()Yes (), no ()Fever (), abdominal pain (), weight loss (), diarrhea ()Spleen alone () or spleen and lymph nodes (); pharynx and cervical muscles (); liver (); liver and lymph nodes (); kidney (), and lymph nodes alone ()Arthritis (x4), myalgia (x5), ND (x2), aphthous ulcer (x7)Yes ()Yes ()Total (), cyclophosphamide (), azathioprine (), methotrexate (), infliximab ()Splenectomy ()Information not providedMean = 1.38 (), range 0–5

Lamport et al. [6]/2238/FCD34/beforeNoLeg weaknessBilateral psoas muscle and epiduralYesYes1

Actis et al. [7]/2330/MCD30/afterYesFever, diarrhea, abdominal painSpleen, abdominal lymph nodesPanniculitis, polyneuropathyYesYesAzathioprineSplenectomy and lymph node excisionPrednisone (stopped after 4th relapse), azathioprine (after last relapse)4

Tirpitz et al. [8]/2480/FUC72/beforeYesAbdominal pain, abdominal swelling, bloody diarrheaBi-temporal upper eyelidsPyoderma gangrenosumYesYesPrednisone, sulfasalazine0

Murata et al. [9]/2518/FUC15/beforeNoFeverSternumArthritisYesYesI&D4

Hara et al. [10]/2639/MUC34/beforeNoPainful facial lesions, fever, nonbloody diarrheaSC scalp, face, right inner canthus, submaxilla, and chestArthritisYesYesI&DSulfasalazine (after relapse)1

Coat et al. [11]/2731/FCD28/beforeYesFever, back painSpleenYesYesAzathioprineSplenectomy1

Kinjo et al. [12]/2834/FUC31/beforeYesFever, bloody stoolSC sternumArthritisNoYesI&D1

Holstein et al. [13]/2926/MCD24/beforeNoFever, diarrhea, weight loss, weakness, loss of appetiteLiver, spleenHLA B27 sacroiliitis, ArthritisYesYesAzathioprineSplenectomyAzathioprine (after 3rd relapse)3

Li et al. [14]/3039/FUC26/beforeYesFever, bloody diarrhea, abdominal painSC left forearmArthritisYesYesI&D0

Coyne [15]/3134/MCD33/beforeNoAbdominal painSpleenNoNoSplenectomy0

Renna et al. [16]/3220/FCD20/concomitantYesFever, abdominal pain, nonbloody diarrhea, weight lossSpleenYesYesSplenectomyPrednisone (before, during, and after relapse)1

Zakout et al. [17]/3329/FCD29/concomitantYesFever, abdominal pain, pain in right shoulder radiating from abdomen, right pleuritic chest pain, nonbloody diarrheaLiverYesNoAzathioprineAzathioprine, sulfasalazine0

Yilmaz et al. [18]/3434/FUC22/beforeYesFever, nasal ache, difficulty with breathingNasal septumYesYesI&D0

Brooks and Ghaffari [19]/3519/FCD19/concomitantYesAbdominal painSpleenPustular skin lesionsYesYesAzathioprineAzathioprine0

Sakharpe et al. [20]/3648/FCDUnknown/beforeNoFever, weakness, loss of appetite, coughing, chest painLiverNoYes0

Boschetti et al. [21]/3740/FCDUnknown/afterNoFever, abdominal painSpleen, pancreasSweet’s syndromeYesYesAdalimumabLaparoscopic biopsy of mesenteric lymph nodesAdalimumab0

Bollegala et al./case 33/MUC18/beforeYesAbdominal pain, fever, weight loss, sweatSpleenPyoderma gangrenosumYesYesInfliximabPrednisone & 5-ASA (before relapse),
infliximab (after relapse)
1

Bollegala et al./case 27/FUC26/beforeNoAbdominal pain, chest pain radiating to left shoulder, fever, weight lossSpleenSweet’s syndrome, oral ulcers, arthritisNoNoInfliximabSplenectomyInfliximab0

AA = aseptic abscess, CD = Crohn’s disease, EIM = extraintestinal manifestation, F = female, IC = indeterminate colitis, IBD = inflammatory bowel disease, I&D = incision and drainage, M = male, ND = neutrophilic dermatosis, SC = subcutaneous, UC = ulcerative colitis.
Case series summary data available.