Cutaneous aseptic abscesses, manifestations of neutrophilic diseases.

Background. Neutrophilic skin disease includes several entities: Sweet synd rome, pyoderma gangrenosum, erythema elevatum diutium, Sneddon-Wilkinson su b-keratous pustulosis, and neutrophilic eccrine hidradenitis. We report two cases of aseptic abscesses which correspond to the deepest anatomoclinical form of neutrophilic dermatosis. Case reports. A 28-year-old man was hospitalized for fever and abdominal pa in with bloody diarrhea in relation with Crohn's disease. The patient also presented two skin abscesses on the lower limbs. Bacteriology specimens wer e negative. The histology specimen of a skin lesion revealed neutrophil inf iltration of the hypodermis without granulomatosis. Systemic corticosteroid therapy was given and rapidly led to resolution of the inflammatory bowel disease and the skin lesions. The patient developed inflammatory spondylart hropathy several months later. The second patient was a 36-year-old woman w ith a history of splenomegaly with asceptic abscesses. She was admitted for abdominal pain with non-bloody diarrhea, fever and multiple joint pain rel ated to spondylarthropathy. She developed several simultaneous abscessed no dules on the legs. Biopsy revealed neutrophil infiltration of the hypodermi s. The diagnosis of neutrophilic disease with aseptic cutaneous and viscera l abscesses was retained. Nonsteroidal antiinflammatory drugs and dapsone w ere given leading to regression of the skin lesions and the abdominal and j oint pain. Discussion. Aseptic skin abscesses result from a deep localization of neutr ophilic disease. They suggest the presence of inflammatory bowel disease, s pondylarthropathy or other aseptic visceral localizations.