Cutaneous Crohn disease without gastrointestinal involvement in a 9-year-old boy

Wang, Jason F.; Melnick, Laura; Penn, Lauren; Brinster, Nooshin; OzaMD, Vikash S

doi:10.5070/d3248041129

Cited by 2 publications

(2 citation statements)

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“…No correlation has been found between the activity of bowel disease and the occurrence of skin lesions [ 4 ], but it is known that patients with colonic involvement of CD are more likely to present MCD than patients with ileal disease alone [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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A Challenging Case of Metastatic Crohn's Disease Without Gastrointestinal Manifestations

Pereira,

Coutinho

2023

Cureus

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Metastatic Crohn's disease (MCD) is a rare cutaneous manifestation of Crohn's Disease (CD), defined as non-caseating, granulomatous skin lesions non-contiguous with the gastrointestinal (GI) tract. Most patients with MCD either have concomitant classic manifestations of CD or develop them within a few months to years. We report a case of MCD without known involvement of the GI tract, after more than three years from diagnosis. After failure or intolerance to several conventional treatments, including oral corticosteroids and azathioprine, adalimumab was initiated with a good response. Diagnosis of cutaneous CD is made by a combination of clinical and histopathological findings. Therapeutic options include topical, intralesional, and systemic corticosteroids as well as topical and systemic immunosuppressants and immunomodulators. Surgical excision may be considered for refractory cases.

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Section: Discussionmentioning

confidence: 99%

“…Other causes of granulomatous dermatitis, such as sarcoidosis, foreign-body granulomas, and mycobacterial and fungal infections, should be considered before assuming the diagnosis of MCD [ 7 ]. The distinction from cutaneous sarcoidosis is particularly challenging as it can be indistinguishable from MCD.…”

Section: Discussionmentioning

confidence: 99%

A Challenging Case of Metastatic Crohn's Disease Without Gastrointestinal Manifestations

Pereira,

Coutinho

2023

Cureus

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Pediatric cutaneous Crohn disease: A case series of 89 patients and review

McKay,

Liu,

Shaw

et al. 2024

Pediatric Dermatology

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BackgroundCutaneous (or “Metastatic”) Crohn disease (CCD) is a rare and underrecognized disease characterized by cutaneous granulomatous inflammation. We describe patient demographics, clinical characteristics, histology, and treatment of 89 pediatric cases of CCD, including 78 previously reported and 11 new cases seen at four academic institutions. We emphasize the efficacy of biologic mono‐ and dual therapy.MethodsPubMed identified cases using keywords including “metastatic Crohn disease” and “cutaneous Crohn disease”. Patients were identified by retrospective review of the electronic health record including histopathologic diagnosis consistent with CCD. Chart review collected demographic, clinical, and histologic data.ResultsMost pediatric patients with CCD are male 55% (49/89), present with edema (73/89, 82%) and erythema (47/89, 53%) of the genitals (33/49, 67%), and have intestinal Crohn disease (69/89, 78%). Oral corticosteroids (53/75, 71%) and metronidazole (29/75, 39%) are the most frequently prescribed medications. Of the 17 patients treated with tumor necrosis factor (TNF)‐blockade, 94% (16/17) had partial or total clearance. Ustekinumab resulted in clearance of cutaneous disease in two patients (2/3, 67%) and partial clearance in one patient (1/3, 33%). Two cases achieved total clearance with the use of dual biologic therapy defined as the use of two biologic therapies with differing mechanisms of action or the use of a biologic therapy and small molecule inhibitor.ConclusionsTNF blockade is an effective treatment for pediatric CCD, and interleukin‐12/23 inhibitors may be similarly effective. Consideration of dual biologic therapy may be useful in pediatric patients requiring discordant therapies for their intestinal and cutaneous CD.

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Cutaneous Crohn disease without gastrointestinal involvement in a 9-year-old boy

Cited by 2 publications

References 25 publications

A Challenging Case of Metastatic Crohn's Disease Without Gastrointestinal Manifestations

A Challenging Case of Metastatic Crohn's Disease Without Gastrointestinal Manifestations

Pediatric cutaneous Crohn disease: A case series of 89 patients and review

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