Bowel-associated dermatosis-arthritis syndrome K91.9

Dicken & Seehafer, 1979

Bowel-associated dermatosis-arthritis syndrome (BADAS) is a rare neutrophilic dermatosis characterized by non-specific, flu-like symptoms, arthritis and skin lesions. The first information on the association between intestinal bypass surgery and arthritis was published in the early 1970s. At that time, it was found that 23% of patients (7 out of 31) developed arthritic symptoms after jejunocolostomy due to obesity. In 1979, Dicken and Seehafer were the first to observe the occurrence of inflammatory skin changes in the form of papules and pustules with a diameter of 2 to 4 mm in patients who had undergone intestinal bypass. As this disease was initially associated exclusively with bariatric surgery, the syndrome was given the name"bowel bypass syndrome". Histopathological examinations revealed similar features to Sweet's syndrome and classified this entity as a neutrophilic dermatosis. A few years later, in 1983, very similar symptoms were observed in four patients, none of whom had a bowel bypass; moreover, each of them suffered from a different gastrointestinal disease. Therefore, it was justified to broaden the clinical picture and rename it"Bowel-associated dermatosis-arthritis syndrome" to include these cases. Today, BADAS has been shown to be associated with inflammatory bowel disease (IBD) and small intestinal bacterial overgrowth (SIBO), among others.

Probably inflammatory response to toxins produced by intestinal bacteria (peptidoglycans; Zhao H et al. 2016).

Days or months after gastrojejunal bypass surgery, clinical symptoms in the form of fever and fatigue, myalgias, tendosynovitides, polyarthralgias and polyarthritides.

Sudden, episodic appearance of round or oval red patches up to 1.0 - 5.0 cm in size, which may transform into flat, edematous papules or large succulent plaques or swellings.

Increasing induration of efflorescences, possibly central vesicle or pustule formation. Sometimes mild itching or pain. Healing after about 1-2 weeks. Furthermore, symmetrical, non-deforming polyarthritis of the peripheral joints is detectable. Muscle pain. Tendinitis (hands, forearms).

In individual cases, in addition to the changes described above, clear cases of erythema nodosum as well as acrodermatitis enteropathica-like skin changes have been observed.

Reminder. The clinical and histological changes are either closely related or identical to Sweet's syndrome! Cases of pyoderma gangraenosum have also been described.

Gonococcal sepsis; acute febrile neutrophilic dermatosis (Sweet Syndrome), aseptic abscess syndrome

Initial use of prednisolone in medium dosage (e.g. 50mg in descending order of dosage) over 10 -14 days.

Alternatively: Broad-spectrum antibiotics such as tetracyclines (e.g. Tetracycline Wolff) 4 times/day 500 mg p.o. or minocycline (e.g. Minoplus) 1-2 times/day 100 mg p.o. or metronidazole (e.g. Clont) up to 1.5 g/day.

Episodic course with recurrences within 4-6 weeks. Mostly spontaneous healing after several relapses. An intermittent course for years is also possible.

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