DISSEMINATED ASEPTIC ABSCESSES ASSOCIATED WITH CROHNS-DISEASE - A NEWENTITY

Our purpose is to describe seven cases of disseminated aseptic abscess es with regard to clinical, biological, radiological, and histological information, treatment, and outcome. Data were collected on seven Cau casian patients who had proven sterile deep abscesses diagnosed in Fre nch university hospitals. The onset of the disease related to abscesse s began at times from June 1988 to August 1994, Follow-up periods were 1 year, 7 months to 8 years, 2 months. The age of the patients ranged from 15 to 26 years old, At onset, all had fever and six had abdomina l pain. Abscesses involved spleen and abdominal lymph nodes in six cas es; liver in three; pancreas, brain, and chest in one, All had polymor phonuclear leukocytosis, Pathological examination showed granulomatous abscesses. Direct and indirect investigations failed to identify any causal microorganism. On six occasions, Crohn's disease was revealed 1 to 41 months later and in one case, it preceded the onset of abscesse s, One subsequently developed Sweet's syndrome. Various antibiotic reg imes were inefficient. Steroids, associated in three cases with immuno suppressive agents, resulted in a rapid improvement in six patients, I n one case, splenectomy followed by 5-ASA therapy was used successfull y. The dramatic effectiveness of steroids and immunosuppressive agents as well as follow-up suggest that disseminated aseptic abscesses migh t be an extraintestinal manifestation of Crohn's disease. Although the pathogenesis of this condition remains unknown, this entity may be re lated to neutrophilic dermatosis in which sterile deep abscesses have been reported.