Bowel-Associated Dermatosis-Arthritis Syndrome (BADAS) as Initial Presentation of Crohnʼs Disease 2094

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; pp. S1190 - S1191
• Main Authors: Ruiz, Jose R., Johnson, Jennie, Gonzales, Gabriel A., Moss, Steven
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
• Subjects: Abdomen; Arthritis; Biopsy; Crohns disease; Gastroenterology; Skin diseases
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-02093

Introduction: Bowel Associated Dermatosis-Arthritis Syndrome (BADAS) is a rare, systemic presentation of an underlying gastrointestinal abnormality, classically described as a complication following ileojejunal bowel surgery. Case Description: 55-year-old woman with no known medical history presented with two weeks worsening facial rash, one day of fevers and 3-months of episodic non-bloody diarrhea. The rash started as facial flushing and small erythematous papules over her cheeks that spread to her forehead. On initial physical examination, she was afebrile and normotensive with honey crusted plaques and pustules on her cheeks and forehead, and papules on her chest, shoulder and abdomen. The rest of her physical exam was unremarkable. No significant laboratory abnormalities were noted on presentation. A Tzanck smear demonstrated multinucleated giant cells. She was started on intravenous acyclovir and broad spectrum antibacterials. Despite treatment, her facial rash evolved into large oozing, crusted pustules. She underwent a shave skin biopsy of a forehead lesion with pustular fluid sent for gram stain and viral PCR. Subsequently, she developed erythematous, tender subcutaneous nodules over her shins, tenderness and synovitis of her wrist, elbow and ankles. A punch biopsy of a leg nodule was performed. Concominantly she developed high fevers, profuse sweats, worsening onset of abdominal cramping associated with increased frequency of soft bloody bowel movements. She underwent colonoscopy with biopsy with the findings shown in figures attached. Given her clinical, endoscopic and histopathologic findings, the patient was diagnosed with an acute flare of previously undiagnosed Crohn's Disease. Intravenous antimicrobials were stopped and she was started on oral prednisone and transitioned to infliximab infusion therapy. Several weeks after initiation of treatment, her rash had nearly resolved with only faint erythematous discoloration of her cheeks remaining. Discussion: This is the first known report of BADAS presenting prior to a diagnosis of IBD. BADAS is presumed to result from a type III immune-mediated response to increased systemic circulating levels of sterile bacterial antigens. It is important to be aware of this syndrome and able to recognize it early in its course to enable timely initiation of appropriate IBD therapy, sparing patients from undergoing extensive antimicrobial therapy and costly diagnostic work ups<./p>