RARE PRESENTATION OF CROHN'S DISEASE: CUTANEOUS METASTASIS

Case Presentation A 23-year-old male patient, diagnosed with Crohn's Disease six years ago, presented with perianal fistulas confirmed by colonoscopy and histopathology. He was treated with infliximab and azathioprine, achieving partial improvement with incomplete healing. After one year, his treatment was optimized due to worsening perianal lesions, including anal fissures, ulcerated perianal lesions, and fistulous openings, consistent with perianal Crohn’s Disease. He developed ulcerated lesions in the intergluteal fold, bilateral inguinal folds, and scars from external perianal orifices, requiring debridement and hyperbaric oxygen therapy. The patient underwent 26 sessions of hyperbaric oxygen therapy over two months, showing improvement but no complete healing, leading him to discontinue due to costs. He had a partial response to other therapies, needing corticosteroids for stabilization. One year later, he was hospitalized with abscesses and ulcerated lesions in the perianal, penile, and inguinal regions (Figure 1). He underwent drainage and biopsy, which showed epithelioid granulomas, Langhans-type giant cells, and microabscesses in glandular crypts, indicating active Crohn's Disease and metastatic Crohn’s (Figure 2). Due to treatment refractoriness, hyperbaric oxygen therapy and biologic therapy (infliximab plus ustekinumab) were indicated. The patient showed improvement in the lesions, weight gain, and quality of life, though complete healing had not yet occurred at follow-up (Figure 3).

Discussion Metastatic Crohn's Disease is characterized by granulomatous skin lesions with histology similar to intestinal tissue. Its pathophysiology is not well understood, but studies suggest a correlation between abnormal T-cell responses in the intestinal mucosa that migrate to the skin as the disease progresses, leading to exposure to skin antigens and lesion formation. Due to its rarity, treatment requires a complex approach depending on the severity, generally involving high-dose steroids, followed by anti-TNF inhibitors like infliximab, and in refractory cases, therapy optimization with ustekinumab and hyperbaric oxygen therapy. In this case, a combination of two biologics was used, an off-label therapy, which yielded satisfactory results for the patient.

Conclusion Metastatic Crohn's Disease is a rare and severe condition requiring prompt intervention and ongoing studies on treatments and their effectiveness. Thus, case descriptions, outcomes, and the applicability of therapeutic approaches are of paramount importance.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025