Common extraintestinal manifestations |
Musculoskeletal |
Arthritis – Colitic type, ankylosing spondylitis, isolated joint involvement such as sacroiliitis. |
Hypertrophic osteoarthropathy – Clubbing, periostitis, metastatic Crohn disease. |
Miscellaneous – Osteoporosis, aseptic necrosis, polymyositis, osteomalacia. |
Skin and mouth |
Reactive lesions – Erythema nodosum, pyoderma gangrenosum, aphthous ulcers, vesiculopustular eruption, cutaneous vasculitis, neutrophilic dermatosis, metastatic Crohn disease, epidermolysis bullosa acquisita. |
Specific lesions – Fissures and fistulas, oral Crohn disease, drug rashes. |
Nutritional deficiency – Acrodermatitis enteropathica (zinc), purpura (vitamins C and K), glossitis (vitamin B), hair loss and brittle nail (protein). |
Associated diseases – Vitiligo, psoriasis, amyloidosis, epidermolysis bullosa acquisita. |
Hepatobiliary |
Specific complications – Sclerosing cholangitis (large-duct or small-duct), bile duct carcinoma, cholelithiasis. |
Associated inflammation – Autoimmune chronic active hepatitis, pericholangitis, portal fibrosis and cirrhosis, granuloma in Crohn disease. |
Metabolic – Fatty liver, gallstones associated with ileal Crohn disease. |
Ocular |
Uveitis iritis, episcleritis, scleromalacia, corneal ulcers, retinal vascular disease, retrobulbar neuritis, Crohn keratopathy. |
Metabolic |
Growth retardation in children and adolescents, delayed sexual maturation. |
Less common extraintestinal manifestations |
Blood and vascular |
Anemia due to iron, folate, or vitamin B12 deficiency or autoimmune hemolytic anemia, anemia of chronic disease, thrombocytopenic purpura; leukocytosis and thrombocytosis; thrombophlebitis and thromboembolism, arteritis and arterial occlusion, polyarteritis nodosa, Takayasu arteritis, cutaneous vasculitis, anticardiolipin antibody, hyposplenism. |
Renal and genitourinary tract |
Urinary calculi (oxalate stones in ileal disease), local extension of Crohn disease involving ureter or bladder, amyloidosis, drug-related nephrotoxicity. |
Renal tubular damage with increased urinary excretion of various enzymes (eg, beta N-acetyl-D-glucosaminidase). |
Neurologic |
Up to 3% of patients may have non-iatrogenic neurologic involvement, including peripheral neuropathy, myelopathy, vestibular dysfunction, pseudotumor cerebri, myasthenia gravis, and cerebrovascular disorders. Incidence equal in ulcerative colitis and Crohn disease. These disorders usually appear 5 to 6 years after the onset of inflammatory bowel disease and are frequently associated with other extraintestinal manifestations. |
Airway and parenchymal lung disease |
Pulmonary fibrosis, vasculitis, bronchitis, necrobiotic nodules, acute laryngotracheitis, interstitial lung disease, sarcoidosis. Abnormal pulmonary function tests without clinical symptoms are common (up to 50% of cases). |
Cardiac |
Pericarditis, myocarditis, endocarditis, and heart block – More common in ulcerative colitis than in Crohn disease; cardiomyopathy, cardiac failure due to anti-TNF therapy. |
Pericarditis may also occur from sulfasalazine/5-aminosalicylates. |
Pancreas |
Acute pancreatitis – More common in Crohn disease than in ulcerative colitis. Risk factors include 6-mercaptopurine and 5-aminosalicylate therapy, duodenal Crohn disease. |
Autoimmune |
Drug-induced lupus and autoimmune diseases secondary to anti-TNF-alpha therapy. |
Positive ANA, anti-double-stranded DNA, cutaneous and systemic manifestations of lupus. |
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