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Bowel-Bypass Syndrome Without Bowel BypassBowel-Associated Dermatosis-Arthritis Syndrome
Joseph L. Jorizzo, MD;
Prapand Apisarnthanarax, MD;
Paul Subrt, MD;
Adelaide A. Hebert, MD;
John C. Henry, MD;
Sharon S. Raimer, MD;
Scott M. Dinehart;
James A. Reinarz, MD
Arch Intern Med. 1983;143(3):457-461.
Abstract
• A recurrent, episodic illness that occurs in as many as 20% of patients who undergo ileojejunal bypass surgery for morbid obesity has been well characterized and includes inflammatory cutaneous lesions with a histologic appearance like that of neutrophilic vasculitis, a nondeforming polyarthritis, and other systemic manifestations. Current concepts of pathogenesis center on overgrowth of bacterial flora in the bypassed bowel segment with subsequent development of a circulating immune complex disease. We report, for the first time to our knowledge, an identical clinicopathologic syndrome in four patients who have not had jejunoileal bypass surgery. Each patient, however, had other gastrointestinal disease that we believe predisposed to this syndrome, possibly via circulating immune complexes with bowel-associated antigens. We propose the expanded term, bowel-associated dermatosis-arthritis syndrome, to incorporate these new cases. We believe that this is not a rare syndrome and that it is easily distinguishable from other types of cutaneous necrotizing vasculitis.
(Arch Intern Med 1983;143:457-461)
Author Affiliations
From the Department of Dermatology (Drs Jorizzo, Apisarnthanarax, Subrt, Hebert, Henry, Raimer, and Mr Dinehart) and the Division of Infectious Diseases, the Department of Internal Medicine (Dr Reinarz), the University of Texas Medical Branch, Galveston.
Footnotes
Accepted for publication Nov 8, 1982.
Reprint requests to the Department of Dermatology, University of Texas Medical Branch, Galveston, TX 77550 (Dr Jorizzo).
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