BSPGHAN 2021 Virtual Annual Meeting

27- 29 April 2021

PEDIATRIC INFLAMMATORY BOWEL DISEASE AND HIDRADENITIS SUPPURATIVE: A CHALLENGING ASSOCIATION?

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David Campbell
David Campbell
2 months ago

Thank you for this report. It is always helpful to be alerted to non-intestinal manifestations of IBD.
Would you recommend anti-TNF earlier in treatment? Is there evidence that the skin responds to anti-TNF?
Did the recto-vaginal fistula heal?
Has a neutrophil function defect and CGD been excluded? There are just a lot of granulomas.

Mark Mahon
Mark Mahon
2 months ago
Reply to  David Campbell

Thanks for your comments and questions Dr Campbell. Apologize for the late reply, with our difference in time zones and a system issue affecting this.

Our patient, had resolution of her fistula after a short course of monoclonal (infliximab) and surgery.

Although quite extensive perineal disease, found to be granulomatous inflammation it was assumed extra-intestinal CD, until her axillary lesions developed. There has ben an established timeframe whereby HD develops in IBD patients; this has been documented at around 10 year. Much later than our patients (Ref: 1)

However, we would suggest medical therapy escalation with monoclonal such as an anti-TNF like infliximab, in the setting of extensive perineal pathology – especially where there is severe IBD phenotype. This is similar to Hurley Stage 3 recommendations when HS is being managed as an isolated entity..

Unfortunately, only 50% respond with dermatological improvement on such therapy, and may require surgical excision of the lesions; for which our patient declines. (Ref: 2)

Lastly, although her lesions were extensive, initially they were localized and without any previous recurrent infections she was not evaluated for a neutrophil function defect; but an interesting point for sure!

  1. Yadav S, Singh S, Varayil JE, Harmsen WS, Zinsmeister AR, Tremaine WJ, Davis MD, Wetter DA, Colombel JF, Loftus Jr EV. Hidradenitis suppurativa in patients with inflammatory bowel disease: a population-based cohort study in Olmsted County, Minnesota. Clinical Gastroenterology and Hepatology. 2016 Jan 1;14(1):65-70.
  2. Nielsen OH, Ainsworth MA. Tumor necrosis factor inhibitors for inflammatory bowel disease. New England Journal of Medicine. 2013 Aug 22;369(8):754-62.
Mark Mahon
Mark Mahon
2 months ago

Happy to answer any questions!

Last edited 2 months ago by Mark Mahon
David Campbell
David Campbell
2 months ago

Thank you Mark, this is very helpful. It would perhaps be important for this child to review neutrophil function, including oxidative burst. AR CGD can certainly present at this age or later.
Well done in keeping up with the time delays also.