Metastatic Cutaneous Crohn’s Disease in Children: Case Report and Review of the Literature

Abstract

Metastatic cutaneous Crohn's disease is a rare complication of Crohn's disease, especially in the pediatric population, and can present a diagnostic dilemma. Most of the reported cases of metastatic cutaneous Crohn's disease in childhood have concurrent gastrointestinal symptoms and/or perianal disease to aid in the diagnosis. We present a case of a 13 1/2-year-old girl whose initial symptom of Crohn's disease was asymptomatic labial swelling. An overview of metastatic cutaneous Crohn's disease in childhood is also provided.

Metastatic Crohn’s disease in pediatrics

“…), pathogenesis, relationship with intestinal disease activity and location, and about which are the most effective treatments against it. Some revisions on this issue are Palamaras et al (6), which include adult and pediatric patients; Keiler et al (7), which include children aged less than 18, and Romero et al (8), including only adults. The latter describes a prevalence of 0.66% over the course of the disease.…”

“…Indeed, in most reports on MCD in children it is a skin lesion the one that initiates the study of probable IBD, with up to 74% of patients presenting unnoticed symptoms compatible with CD, especially unspecific symptoms such as recurrent abdominal pain, diarrhea, constipation or growth retardation. More striking is that up to 78% of patients suffered from concomitant perianal disease (anal fissures, fistulae, abscesses or perianal erythema) (6,7,11).…”

Unilateral, non‐tender, vulvar swelling as the presenting sign of Crohn’s disease: A case report and our suggestion for early diagnosis

“…1 Most of the reported cases have been clinically misdiagnosed as cellulitis, erysipelas, lichenoid eruptions and various sexually transmitted diseases 1 and vulvar swelling as a manifestation of CD commonly misdiagnosed as cellulitis or sexual abuse. 10 So, non-tenderness or painlessness in MCD could be an important clinical feature in the differential diagnosis with infectious diseases. Many reported vulvar CD were painless, especially when occurring in children.…”

“…Many reported vulvar CD were painless, especially when occurring in children. [4][5][6][8][9][10][11] In Table 1, pain was not observed in six out of nine cases, and in the remaining three cases, vulvar symptom was not described. We speculate that those three cases would have been painless because the authors would have probably stated the symptom if there was pain or tenderness.…”

“…Presence of perianal disease was noted on presentation in 81% of pediatric patients with MCD. 10 Therefore, if a patient presents vulvar swelling, careful examination of the anus as well as the vulva is needed. Because vulvar CD is very rare, there is no consistent treatment for genital CD.…”