Metastatic crohns disease

Metastatic crohns disease DEFAULT

Metastatic Crohn's disease of the bladder

Metastatic Crohn's disease (MCD) is a rare complication of Crohn's disease that has been described in the liver, lung, spleen, skin, and bone. Granulomas distinct from the gastrointestinal tract are the hallmark feature of the disease. Patients may present with MCD during periods of quiescent gastrointestinal disease, complicating diagnosis. We describe a case of granulomatous inflammation of the bladder in a patient with quiescent ileocolonic Crohn's disease. After a delayed diagnosis, the patient was treated with high-dose corticosteroids with an initial response. Her disease course was complicated by a vesicovaginal fistula, which was effectively treated initially with infliximab and then adalimumab.

To the Editor:

We have recently seen a case of metastatic Crohn's disease (MCD) in the bladder. This is the second reported case of MCD of the bladder in the English-language literature and the first to be treated with biologic therapy.

A 69-year-old white woman with a 40-year history of ileocolonic Crohn's disease presented with a history of urinary incontinence. Her Crohn's history dated to 1973, at which time she had had an ileocolonic resection with ileo-ascending colon anastomosis for active inflammatory disease. She did well postoperatively for approximately 10 years and then developed mild symptoms, for which she was treated with mesalamine. In 2003, her symptoms worsened, and she was treated with steroids and started on infliximab. Despite this therapy, she developed a bowel obstruction leading to surgical resection of an anastomotic stricture. The patient was given azathioprine postoperatively but did not tolerate this therapy. Her infliximab was not restarted at that time.

Since this surgery she has had no bowel complaints, but several months post-operatively she began to experience dysuria, hematuria, and urinary incontinence. Urine cultures were sterile. She was treated empirically with multiple courses of antibiotics, urethral Botox® injections, and sacral nerve stimulation with no improvement in her symptoms. A cystoscopy in 2004 showed no evidence of an enterovesicular fistula, but random bladder biopsies showed urothelium with active inflammation, granulation tissue, and a noncaseating granuloma (Figs. 1 and 2). Acid-fast bacilli and Gomori's methenamine stains were negative. A diagnosis of Crohn's disease of the bladder was made. The patient was then started on 80 mg/day of prednisone with good result. She was tapered to 10 mg/day, below which she would have significant incontinence. She remained on this dose for 2 years and then developed recurrent high-volume incontinence. An endoscopic and radiographic workup failed to reveal any active intestinal inflammation, but urologic testing revealed a new vesicovaginal fistula. Treatment with 6-mercaptopurine and azathioprine were not offered given her prior intolerance to these medications. She was therefore pretreated with prednisone and rechallenged with infliximab. She had no clinical response to the first infusion and with the second infusion developed rapid atrial fibrillation, and the medication was discontinued. She was then started on adalimumab.

The patient tolerated adalimumab with a loading dose of 160 mg at time 0, then an injection of 80 mg at week 2, and then 40 mg every other week after that. The patient was able to be weaned off her steroids and continued to deny any gastrointestinal symptoms. However, her urinary incontinence persisted, and she underwent primary repair of the fistula without complication. At surgery there was no evidence of active or quiescent intestinal Crohn's disease. She has done well postoperatively and continues on adalimumab for disease control.

Urinary tract involvement is a rare but clinically significant complication of Crohn's disease. The most frequent urinary tract complication of Crohn's disease is enteric fistulas to the bladder.1 Other complications include nephrolithiasis, often a consequence of ileal resection or ileostomy formation, and intrinsic renal disease in the form of amyloidosis, IgA nephropathy, interstitial nephritis and obstructive uropathy.

This case describes an extremely rare urinary tract manifestation, namely MCD to the bladder. The term MCD was first used by Mountain in 1970 to refer to granulomatous skin lesions distinct from the gastrointestinal tract with pathologic features of Crohn's disease.2 Since then, granulomas have been reported in many organs outside the gastrointestinal (GI) tract in patients with Crohn's disease including the lung, liver, spleen, and bone.

In the lung, granulomatous disease of the trachea, bronchioles, and interstium has been reported.3,5 The patients in these cases had varying levels of activity of their GI disease ranging from active to quiescent disease when their respiratory symptoms began. Chest imaging was abnormal in all cases, and infectious causes were ruled out. Bronchoscopic and/or thoracoscopic lung biopsies demonstrated noncaseating granulomas in all cases.

Granulomas in the liver have been found in patients with Crohn's disease with the presence of the lesions correlating with disease activity. Gill and Mahadevan described the case of a 20-year-old African-American woman with active Crohn's disease of the colon incidentally found to have pulmonary and hepatic nodules on abdominal imaging.6 Biopsy of one of the liver lesions revealed noncaseating granulomas with multinucleated giant cells. Treatment with infliximab led to progressive resolution of both the hepatic and pulmonary nodules. Holstein et al described the case of a young man with ileocolonic Crohn's disease who presented with abdominal pain and diarrhea.7 Ultrasound and computed tomography showed multiple hepatic and splenic lesions that on biopsy demonstrated epithelioid cell granulomas with no microorganisms in both the liver and spleen. Treatment consisting of prednisolone, splenectomy, and azathioprine led to clinical resolution.

With regard to MCD of the bladder, there is only one other case reported in the English-language literature of this entity. In that case, in contrast to ours, the patient had active Crohn's disease in the GI tract.8 Surgical resection of the affected portions of the bowel and bladder resulted in prolonged remission. Our patient had quiescent bowel disease when she developed urinary symptoms. These symptoms improved with corticosteroids, but she nonetheless developed fistulizing disease. Surgical therapies that might be considered for vesicovaginal fistulas of other etiologies (e.g., formation of an ileal conduit with anastomosis of the ureters to the bowel) were avoided initially in this case due to the possibility of flaring of the patient's quiescent intestinal disease given that the location of the fistula was outside the gastrointestinal tract. To that end, she was treated with adalimumab, which to our knowledge is the first case of metastatic Crohn's disease to be treated with this medication.

The pathophysiology of metastatic Crohn's disease is unknown, but it may be caused by the same pathologic processes that occur in the GI tract.9 Case reports such as ours suggest that immunosuppression with corticosteroids and tumor necrosis factor alpha inhibitors improves symptoms. However, further investigation is required to better understand this clinically important, albeit rare, complication of Crohn's disease.

References

1.
3.

Xia

K

,

Wolf

J

,

Friedman

S

, et al.  Granulomatous tracheo-bronchitis associated with Crohn's disease.

MedGenMed

2004

;

6

:

18

.
4.

Vandenplas

O

,

Casel

S

,

Delos

M

, et al.  Granulomatous bronchiolitis associated with Crohn's disease.

Am J Respir Crit Care Med.

1998

;

158

:

1676

1679

.
5.

Lucero

PF

,

Frey

WC

,

Schaffer

RT

, et al.  Granulomatous lung masses in an elderly patient with inactive Crohn's disease.

Inflamm Bowel Dis.

2001

;

7

:

256

259

.
6.

Gill

KRS

,

Mahadevan

U

. Infliximab for the treatment of metastatic hepatic and pulmonary Crohn's disease.

Inflamm Bowel Dis.

2005

;

11

:

210

212

.
7.

Holstein

A

,

Egberts

E-H

,

Von Herbay

A

. Rheumatoid-like nodules in the spleen: new extraintestinal manifestation of Crohn's disease?

J Gastroenterol Hepatol.

2006

;

21

:

295

298

.
8.

Molnar

T

,

Tiszlavicz

L

,

Balagh

A

, et al.  Crohn's disease of the bladder—a new type of metastatic granulomatous inflammatory bowel disease.

Am J Gastroenterol.

2000

;

95

:

850

851

.
9.

Das

KM

. Relationship of extraintestinal involvements in inflammatory bowel disease: new insights into autoimmune pathogenesis.

Dig Dis Sci.

1999

;

44

:

1

13

.

Author notes

Copyright © 2007 Crohn's & Colitis Foundation of America, Inc.

Sours: https://academic.oup.com/ibdjournal/article/14/1/140/4653635

METASTATIC CROHN'S DISEASE OF EXTERNAL GENITALIA

1. Goyal A, Mansel RE, Young HL, Douglas-Jones A. Metastatic cutaneous Crohn's disease of the nipple: Report of a case. Dis Colon Rectum. 2006;49:132–4. [PubMed] [Google Scholar]

2. Burgdorf W. Cutaneous manifestations of Crohn's disease. J Am Acad Dermatol. 1981;5:689–95. [PubMed] [Google Scholar]

3. Parks AG, Morson BC, Pegum JS. Crohn's disease with cutaneous involvement. Proc R Soc Med. 1965;58:241–2.[PMC free article] [PubMed] [Google Scholar]

4. Mountain JC. Cutaneous ulceration in Crohn's disease. Gut. 1970;11:18–26.[PMC free article] [PubMed] [Google Scholar]

5. Guest GD, Fink RL. Metastatic Crohn's disease: Case report of an unusual variant and review of the literature. Dis Colon Rectum. 2000;43:1764–6. [PubMed] [Google Scholar]

6. Sangueza OP, Davis LS, Gourdin FW. Metastatic Crohn's disease. South Med J. 1997;90:897–900. [PubMed] [Google Scholar]

7. Hackzell-Bradley M, Hedblad MA, Stephansson EA. Metastatic Crohn's disease: Report of 3 cases with special reference to histopathologic findings. Arch Dermatol. 1996;132:928–32. [PubMed] [Google Scholar]

8. Burgdorf W, Orkin M. Granulomatous perivasculitis in Crohn's disease. Arch Dermatol. 1981;117:674–5. [PubMed] [Google Scholar]

9. Perret CM, Bahmer FA. Extensive necrobiosis in metastatic Crohn's disease. Dermatologica. 1987;175:208–12. [PubMed] [Google Scholar]

10. Brady CE, 3rd, Cooley BJ, Davis JC. Healing of severe perineal and cutaneous Crohn's disease with hyperbaric oxygen. Gastroenterology. 1989;97:756–60. [PubMed] [Google Scholar]

11. Williams N, Scott NA, Watson JS, Irving MH. Surgical management of perineal and metastatic cutaneous Crohn's disease. Br J Surg. 1993;80:1596–8. [PubMed] [Google Scholar]

12. van Dullemen HM, de Jong E, Slors F, Tytgat GN, van Deventer SJ. Treatment of therapy-resistant perineal metastatic Crohn's disease after proctectomy using anti-tumor necrosis factor chimeric monoclonal antibody, cA2: Report of two cases. Dis Colon Rectum. 1998;41:98–102. [PubMed] [Google Scholar]

13. Miller AM, Elliott PR, Fink R, Connell W. Rapid response of severe refractory metastatic Crohn's disease to infliximab. J Gastroenterol Hepatol. 2001;16:940–2. [PubMed] [Google Scholar]

14. Escher JC, Stoof TJ, van Deventer SJ, van Furth AM. Successful treatment of metastatic Crohn disease with infliximab. J Pediatr Gastroenterol Nutr. 2002;34:420–3. [PubMed] [Google Scholar]

15. Rispo A, Lembo G, Insabato L, Cozzolino A, Pesce G, Castiglione F. Successful treatment of therapy-resistant metastatic Crohn's disease with infliximab. Br J Dermatol. 2004;150:1045–6. [PubMed] [Google Scholar]

16. Graham DB, Jager DL, Borum ML. Metastatic Crohn's disease of the face. Dig Dis Sci. 2006;51:2062–3. [PubMed] [Google Scholar]

17. Konrad A, Seibold F. Response of cutaneous Crohn's disease to infliximab and methotrexate. Dig Liver Dis. 2003;35:351–6. [PubMed] [Google Scholar]

Sours: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763745/
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Metastatic Crohn Disease: A Review of Dermatologic Manifestations and Treatment

Practice Points

  • Almost half of patients with Crohn disease develop a dermatologic manifestation of the disease.
  • The etiology of metastatic Crohn disease is unknown and diagnosis requires a high index of suspicion with exclusion of other processes.

References

  1. Parks AG, Morson BC, Pegum JS. Crohn's disease with cutaneous involvement. Proc R Soc Med. 1965;58:241-242.
  2. Friedman S, Blumber RS. Inflammatory bowel disease. In: Kasper DL, Braunwald E, Fauci AS, et al, eds. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005:1778-1784.
  3. Moutain JC. Cutaneous ulceration in Crohn's disease. Gut. 1970;11:18-26.
  4. Lester LU, Rapini RP. Dermatologic manifestations of colonic disorders. Curr Opin Gastroenterol. 2008;25:66-73.
  5. Teixeira M, Machado S, Lago P, et al. Cutaneous Crohn's disease. Int J Dermatol. 2006;45:1074-1076.
  6. Simoneaux SF, Ball TI, Atkinson GO Jr. Scrotal swelling: unusual first presentation of Crohn's disease. Pediatr Radiol. 1995;25:375-376.
  7. Albuquerque A, Magro F, Rodrigues S, et al. Metastatic cutaneous Crohn's disease of the face: a case report and review of literature. Eur J Gastroenterol Hepatol. 2011;23:954-956.
  8. Palamaras I, El-Jabbour J, Pietropaolo N, et al. Metastatic Crohn's disease: a review. J Eur Acad Dermatol Venereol. 2008;22:1033-1043.
  9. Ploysangam T, Heubi JE, Eisen D, et al. Cutaneous Crohn's disease in children. J Am Acad Dermatol. 1997;36:697-704.
  10. Vint R, Husain E, Hassain F, et al. Metastatic Crohn's disease of the penis: two cases. Int Urol Nephrol. 2012;44:45-49.
  11. Burgdorf W. Cutaneous manifestations of Crohn's disease. J Am Acad Dermatol. 1981;5:689-695.
  12. Resnick MI, Kursh ED. Extrinsic obstruction of the ureter. In: Walsh PC, Retik AB, Stamey TA, et al, eds. Campbell's Urology. 7th ed. Philadelphia, PA: WB Saunders; 1998:400-402.
  13. Samitz MH, Dana AS Jr, Rosenberg P. Cutaneous vasculitis in association with Crohn's disease--review of statistics of skin complications. Cutis. 1970;6:51-56.
  14. Emanuel PO, Phelps RG. Metastatic Crohn's disease: a histo-pathologic study of 12 cases. J Cutan Pathol. 2008;35:457-461.
  15. Slater DN, Waller PC, Reilly G. Cutaneous granulomatous vasculitis: presenting features of Crohn's disease. J R Soc Med. 1985;78:589-590.
  16. Tatnall FM, Dodd HJ, Sarkany I. Crohn's disease with metastatic cutaneous involvement and granulomatous cheilitis. J R Soc Med. 1987;80:49-51.
  17. Shum DT, Guenther L. Metastatic Crohn's disease: case report and review of literature. Arch Dermatol. 1990;126:645-648.
  18. Bernstein CN, Sargent M, Gallatin WM. Beta2 integrin/ICAM expression in Crohn's disease. Clin Immunol Immunopathol. 1998;86:147-160.
  19. Grimm MC, Pavli P, Van de Pol E, et al. Evidence for a CD-14+ population of monocytes in inflammatory bowel disease mucosa--implications for pathogenesis. Clin Exp Immunol. 1995;100:291-297.
  20. Pokorny RM, Hofmeister A, Galandiuk S, et al. Crohn's disease and ulcerative colitis are associated with the DNA repair gene MLH1. Ann Surg. 1997;225:718-723; discussion 723-725.
  21. Ursing B, Kamme C. Metronidazole for Crohn's disease. Lancet. 1975;1:775-777.
  22. Crowson AN, Nuovo GJ, Mihm MC Jr, et al. Cutaneous manifestations of Crohn's disease, its spectrum, and pathogenesis: intracellular consensus bacterial 16S rRNA is associated with the gastrointestinal but not the cutaneous manifestations of Crohn's disease. Hum Pathol. 2003;34:1185.
  23. Leu S, Sun PK, Collyer J, et al. Clinical spectrum of vulva metastatic Crohn's disease. Dig Dis Sci. 2009;54:1565-1571.
  24. Chen W, Blume-Peytavi U, Goerdt S, et al. Metastatic Crohn's disease of the face. J Am Acad Dermatol. 1996;35:986-988.
  25. Ogram AE, Sobanko JF, Nigra TP. Metastatic cutaneous Crohn disease of the face: a case report and review of the literature. Cutis. 2010;85:25-27.
  26. Graham D, Jager D, Borum M. Metastatic Crohn's disease of the face. Dig Dis Sci. 2006;51:2062-2063.
  27. Biancone L, Geboes K, Spagnoli LG, et al. Metastatic Crohn's disease of the forehead. Inflamm Bowel Dis. 2002;8:101-105.
  28. Kolansky G, Green CK, Dubin H. Metastatic Crohn's disease of the face: an uncommon presentation. Arch Dermatol. 1993;129:1348-1349.
  29. Mahadevan U, Sandborn WJ. Infliximab for the treatment of orofacial Crohn's disease. Inflamm Bowel Dis. 2001;7:38-42.
  30. McCallum DI, Gray WM. Metastatic Crohn's disease. Br J Dermatol. 1976;95:551-554.
  31. Lieberman TR, Greene JF Jr. Transient subcutaneous granulomatosis of the upper extremities in Crohn's disease. Am J Gastroenterol. 1979;72:89-91.
  32. Kafity AA, Pellegrini AE, Fromkes JJ. Metastatic Crohn's disease: a rare cutaneous manifestation. J Clin Gastroenterol. 1993;17:300-303.
  33. Marotta PJ, Reynolds RP. Metastatic Crohn's disease. Am J Gastroenterol. 1996;91:373-375.
  34. Hackzell-Bradley M, Hedblad MA, Stephansson EA. Metastatic Crohn's disease. report of 3 cases with special reference to histopathologic findings. Arch Dermatol. 1996;132:928-932.
  35. van Dulleman HM, de Jong E, Slors F, et al. Treatment of therapy resistant perineal metastatic Crohn's disease after proctectomy using anti-tumor necrosis factor chimeric monoclonal antibody, cA2: report of two cases. Dis Colon Rectum. 1998;41:98-102.
  36. Lavery HA, Pinkerton JH, Sloan J. Crohn's disease of the vulva--two further cases. Br J Dermatol. 1985;113:359-363.
  37. Lally MR, Orenstein SR, Cohen BA. Crohn's disease of the vulva in an 8-year-old girl. Pediatr Dermatol. 1988;5:103-106.
  38. Tuffnell D, Buchan PC. Crohn's disease of the vulva in childhood. Br J Clin Pract. 1991;45:159-160.
  39. Schrodt BJ, Callen JP. Metastatic Crohn's disease presenting as chronic perivulvar and perirectal ulcerations in an adolescent patient. Pediatrics. 1999;103:500-502.
  40. Slaney G, Muller S, Clay J, et al. Crohn's disease involving the penis. Gut. 1986;27:329-333.
  41. Calder CJ, Lacy D, Raafat F, et al. Crohn's disease with pulmonary involvement in a 3 year old boy. Gut. 1993;34:1636-1638.
  42. Saha S, Fichera A, Bales G, et al. Metastatic Crohn's disease of the bladder. Inflamm Bowel Dis. 2008;14:140-142.
  43. Escher JC, Stoof TJ, van Deventer SJ, et al. Successful treatment of metastatic Crohn disease with infliximab. J Pediatr Gastroenterol Nutr. 2002;34:420-423.
  44. Saadah OI, Oliver MR, Bines JE, et al. Anorectal strictures and genital Crohn's disease: an unusual clinical association. J Pediatr Gastroenterol Nutr. 2003;36:403-406.
  45. Martinez-Salamanca JI, Jara J, Miralles P, et al. Metastatic Crohn's disease: penile and scrotal involvement. Scand J Urol Nephrol. 2004;38:436-437.
  46. Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002;347:417-429.
  47. Acker SM, Sahn EE, Rogers HC, et al. Genital cutaneous Crohn disease. Am J Dermatopathol. 2000;22:443-446.
  48. Lestre S, Ramos J, Joao A, et al. Cutaneous Crohn's disease presenting as genital warts: successful treatment with adalimumab. Eur J Dermatol. 2010;20:504-505.
  49. Yu JT, Chong LY, Lee KC. Metastatic Crohn's disease in a Chinese girl. Hong Kong Med J. 2006;12:467-469.
  50. Wilson-Jones E, Winkelmann RK. Superficial granulomatous pyoderma: a localized vegetative form of pyoderma gangrenosum. J Am Acad Dermatol. 1988;18:511-521.
  51. Moyes LH, Glen P, Pickford IR. Perineal metastatic Crohn's disease: a case report and review of the literature. Ann R Coll Surg Engl. 2007;89:W1-W3.
  52. Rajpara SM, Siddha SK, Ormerod AD, et al. Cutaneous penile and perianal Crohn's disease treated with a combination of medical and surgical interventions. Australas J Dermatol. 2008;49:21-24.
  53. Cockburn AG, Krolikowski J, Balogh K, et al. Crohn disease of penile and scrotal skin. Urology. 1980;15:596-598.
  54. Guest GD, Fink RL. Metastatic Crohn's disease: case report of an unusual variant and review of the literature. Dis Colon Rectum. 2000;43:1764-1766.
  55. Sangueza OP, Davis LS, Gourdin FW. Metastatic Crohn disease. South Med J. 1997;90:897-900.
  56. Chiba M, Iizuka M, Horie Y, et al. Metastatic Crohn's disease involving the penis. J Gastroenterol. 1997;32:817-821.
  57. Poon KS, Gilks CB, Masterson JS. Metastatic Crohn's disease involving the genitalia. J Urol. 2002;167:2541-2542.
  58. Shanahan F. Anti-TNF therapy for Crohn's disease: a perspective (infliximab is not the drug we have been waiting for). Inflamm Bowel Dis. 2000;6:137-139.
  59. Carranza DC, Young L. Successful treatment of metastatic Crohn's disease with cyclosporine. J Drugs Dermatol. 2008;7:789-791.
  60. Bardazzi F, Guidetti MS, Passarini B, et al. Cyclosporine A in metastatic Crohn's disease. Acta Derm Venereol. 1995;75:324-325.
  61. Faubion WA Jr, Loftus EV Jr, Harmsen WS, et al. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology. 2001;121:255-260.
  62. Gelbmann CM, Rogler G, Gross V, et al. Prior bowel resections, perianal disease, and a high initial Crohn's disease activity index are associated with corticosteroid resistance in active Crohn's disease. Am J Gastroenterol. 2002;97:1438-1445.
  63. Thukral C, Travassos WJ, Peppercorn MA. The role of antibiotics in inflammatory bowel disease. Curr Treat Options Gastroenterol. 2005;8:223-228.
  64. Brandt LJ, Berstein LH, Boley SJ, et al. Metronidazole therapy for perineal Crohn's disease: a follow-up study. Gastroenterology. 1982;83:383-387.
  65. Lehrnbecher T, Kontny HU, Jeschke R. Metastatic Crohn's disease in a 9-year-old boy. J Pediatr Gastroenterol Nutr. 1999;28:321-323.
  66. Abide JM. Metastatic Crohn disease: clearance with metronidazole. J Am Acad Dermatol. 2011;64:448-449.
  67. Rispo A, Scarpa R, Di Girolamo E, et al. Infliximab in the treatment of extra-intestinal manifestations of Crohn's disease. Scand J Rheumatol. 2005;34:387-391.
  68. Kaufman I, Caspi D, Yeshurun D, et al. The effect of infliximab on extraintestinal manifestations of Crohn's disease. Rheumatol Int. 2005;25:406-410.
  69. Konrad A, Seibold F. Response of cutaneous Crohn's disease to infliximab and methotrexate. Dig Liver Dis. 2003;35:351-356.
  70. Miller AM, Elliott PR, Fink R, et al. Rapid response of severe refractory metastatic Crohn's disease to infliximab. J Gastroenterol Hepatol. 2001;16:940-942.
  71. Chuah JH, Kim DS, Allen C, et al. Metastatic Crohn's disease of the ear. Int J Otolaryngol. 2009;2009:871567.
  72. Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med. 1999;340:1398-1405.
  73. Petrolati A, Altavilla N, Cipolla R, et al. Cutaneous metastatic Crohn's disease responsive to infliximab. Am J Gastroenterol. 2009;104:1058.
  74. Hanauer SB, Sandborn WJ, Rutgeerts P, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn's disease: the CLASSIC-I trial. Gastroenterology. 2006;130:323-333.
  75. Cury DB, Moss A, Elias G, et al. Adalimumab for cutaneous metastatic Crohn's disease. Inflamm Bowel Dis. 2010;16:723-724.

Almost half of Crohn disease (CD) patients experience a dermatologic manifestation of the disease. A rare entity, metastatic CD (MCD) presents a diagnostic challenge without a high index of suspicion. Its etiology is not well defined; however, it appears to be an autoimmune response to gut antigens. Herein, we review the etiology/epidemiology, diagnostic criteria, and treatment for this uncommon condition.

Epidemiology and Clinical Characteristics of MCD

Metastatic CD was first described by Parks et al1 in 1965 and refers to a diverse collection of macroscopic dermatologic manifestations in tissue not contiguous with the gastrointestinal (GI) tract. To be classified as MCD, the tissue must demonstrate characteristic histopathologic findings, which invariably include noncaseating granulomas.

Crohn disease may affect any part of the GI tract from the mouth to anus, with a multitude of associated cutaneous manifestations having been described. The terminal ileum is the most commonly affected portion of the GI tract in CD, but the large intestine also may be involved in 55% to 80% of cases.2 The incidence of non-MCD-associated anal lesions seems to correlate with intestinal involvement in that as few as 25% of patients with ileal-localized CD have anal lesions compared to nearly 80% of patients with large intestinal involvement.3

It has been estimated that 18% to 44% of patients with CD have some form of cutaneous manifestation,4 with MCD being a rare subcategory. As few as 100 cases have been described from 1965 to the present.5 The presence of MCD does not correlate well with severity of intestinal CD, and although a majority of MCD cases present after at least 6 months of GI symptoms,6 there are instances in which MCD presents without prior or existing evidence of intestinal CD.7

With regard to MCD, the term metastatic is sometimes supplanted in the literature by cutaneous to avoid any implication of cancer; however, due to a myriad of dermatologic manifestations, both terms can cause confusion. The categorization of the various types of cutaneous findings in CD is well summarized in a review by Palamaras et al8 with the following classifications: (1) granulomatous by direct extension (oral or perianal), (2) MCD lesions (genital and nongenital), (3) immune-related lesions, and (4) lesions from nutritional deficiencies. Of the cutaneous manifestations relating to CD, MCD is the least common cutaneous categorical manifestation and is further divided into subcategories of genital and nongenital lesions.8

The nongenital distribution of MCD is the more common variety in adults and particularly seems to affect the legs and plantar surfaces (38%), the trunk and abdomen (24%), and the face (15%).5,9 These nongenital MCD manifestations are most commonly described as nodules, ulcerations, or erythematous to purple plaques, and less commonly described as abscesses, pustules, or papules.

The sequence of cutaneous symptoms of MCD relative to intestinal disease depends to some degree on patient age. In adults diagnosed with MCD, it has been noted that a GI flare is expected 2 months to 4 years after diagnosis; however, in children the subsequent GI flare has been noted to vary more widely from 9 months to 14 years following presentation of MCD.8 Furthermore, roughly 50% of children diagnosed with MCD present concomitantly with their first symptoms of a GI flare, whereas 70% of adults with MCD had been previously diagnosed with intestinal CD.8 In one review of 80 reported cases of MCD, 20% (16/80) had no symptoms of intestinal disease at the time of MCD diagnosis, and the majority of the asymptomatic cases were in children; interestingly, the majority of these same children were diagnosed with CD months to years later.9

Both the location and characteristics of cutaneous findings in MCD correlate with age.9 Metastatic CD has been identified in all age groups; however, lymphedema is more common in children/young adults, while nodules, ulceration, and fistulating disease are more often seen in adults.10 Affected children and adolescents with MCD range from 5 to 17 years of age, with a mean age at disease onset of 11.1 years and equal incidence in males and females.8 Adults with MCD range from 18 to 78 years of age, with a mean age at presentation of 38.4 years.8,11

Concerning anatomic location of disease, adults with MCD most commonly have nodules with or without plaques on the arms and legs and less commonly in the genital area.8 In contrast, children with MCD are more prone to genital lesions, with up to 85% of cases including some degree of genital erythematous or nonerythematous swelling with or without induration.8 Genitourinary complications of CD as a broad category, however, are estimated to occur in only 5% to 20% of intestinal CD cases in both children and adults.12

There have been conflicting reports regarding gender predilection in MCD. Based on a review by Samitz et al13 of 200 cases of CD over an 18-year period, 22% of patients with CD were found to have cutaneous manifestations--presumably not MCD but rather perianal, perineal, vulvar fistulae, fissures, or abscesses--with a male to female preponderance of almost 2 to 1. A more recent review of the literature by Palamaras et al8 in 2008 reported that contiguous non-MCD affects adult females and children more often than adult males, with 63% adult cases being female. This review seems to be more congruent with other reports in the literature implicating that females are twice as commonly affected by MCD than males.9,14

References

  1. Parks AG, Morson BC, Pegum JS. Crohn's disease with cutaneous involvement. Proc R Soc Med. 1965;58:241-242.
  2. Friedman S, Blumber RS. Inflammatory bowel disease. In: Kasper DL, Braunwald E, Fauci AS, et al, eds. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005:1778-1784. 
  3. Moutain JC. Cutaneous ulceration in Crohn's disease. Gut. 1970;11:18-26. 
  4. Lester LU, Rapini RP. Dermatologic manifestations of colonic disorders. Curr Opin Gastroenterol. 2008;25:66-73.
  5. Teixeira M, Machado S, Lago P, et al. Cutaneous Crohn's disease. Int J Dermatol. 2006;45:1074-1076.
  6. Simoneaux SF, Ball TI, Atkinson GO Jr. Scrotal swelling: unusual first presentation of Crohn's disease. Pediatr Radiol. 1995;25:375-376.
  7. Albuquerque A, Magro F, Rodrigues S, et al. Metastatic cutaneous Crohn's disease of the face: a case report and review of literature. Eur J Gastroenterol Hepatol. 2011;23:954-956.
  8. Palamaras I, El-Jabbour J, Pietropaolo N, et al. Metastatic Crohn's disease: a review. J Eur Acad Dermatol Venereol. 2008;22:1033-1043.
  9. Ploysangam T, Heubi JE, Eisen D, et al. Cutaneous Crohn's disease in children. J Am Acad Dermatol. 1997;36:697-704.
  10. Vint R, Husain E, Hassain F, et al. Metastatic Crohn's disease of the penis: two cases. Int Urol Nephrol. 2012;44:45-49.
  11. Burgdorf W. Cutaneous manifestations of Crohn's disease. J Am Acad Dermatol. 1981;5:689-695. 
  12. Resnick MI, Kursh ED. Extrinsic obstruction of the ureter. In: Walsh PC, Retik AB, Stamey TA, et al, eds. Campbell's Urology. 7th ed. Philadelphia, PA: WB Saunders; 1998:400-402.
  13. Samitz MH, Dana AS Jr, Rosenberg P. Cutaneous vasculitis in association with Crohn's disease--review of statistics of skin complications. Cutis. 1970;6:51-56.
  14. Emanuel PO, Phelps RG. Metastatic Crohn's disease: a histo-pathologic study of 12 cases. J Cutan Pathol. 2008;35:457-461.
  15. Slater DN, Waller PC, Reilly G. Cutaneous granulomatous vasculitis: presenting features of Crohn's disease. J R Soc Med. 1985;78:589-590.
  16. Tatnall FM, Dodd HJ, Sarkany I. Crohn's disease with metastatic cutaneous involvement and granulomatous cheilitis. J R Soc Med. 1987;80:49-51.
  17. Shum DT, Guenther L. Metastatic Crohn's disease: case report and review of literature. Arch Dermatol. 1990;126:645-648. 
  18. Bernstein CN, Sargent M, Gallatin WM. Beta2 integrin/ICAM expression in Crohn's disease. Clin Immunol Immunopathol. 1998;86:147-160.
  19. Grimm MC, Pavli P, Van de Pol E, et al. Evidence for a CD-14+ population of monocytes in inflammatory bowel disease mucosa--implications for pathogenesis. Clin Exp Immunol. 1995;100:291-297.
  20. Pokorny RM, Hofmeister A, Galandiuk S, et al. Crohn's disease and ulcerative colitis are associated with the DNA repair gene MLH1. Ann Surg. 1997;225:718-723; discussion 723-725.
  21. Ursing B, Kamme C. Metronidazole for Crohn's disease. Lancet. 1975;1:775-777.
  22. Crowson AN, Nuovo GJ, Mihm MC Jr, et al. Cutaneous manifestations of Crohn's disease, its spectrum, and pathogenesis: intracellular consensus bacterial 16S rRNA is associated with the gastrointestinal but not the cutaneous manifestations of Crohn's disease. Hum Pathol. 2003;34:1185.
  23. Leu S, Sun PK, Collyer J, et al. Clinical spectrum of vulva metastatic Crohn's disease. Dig Dis Sci. 2009;54:1565-1571.
  24. Chen W, Blume-Peytavi U, Goerdt S, et al. Metastatic Crohn's disease of the face. J Am Acad Dermatol. 1996;35:986-988.
  25. Ogram AE, Sobanko JF, Nigra TP. Metastatic cutaneous Crohn disease of the face: a case report and review of the literature. Cutis. 2010;85:25-27.
  26. Graham D, Jager D, Borum M. Metastatic Crohn's disease of the face. Dig Dis Sci. 2006;51:2062-2063.
  27. Biancone L, Geboes K, Spagnoli LG, et al. Metastatic Crohn's disease of the forehead. Inflamm Bowel Dis. 2002;8:101-105.
  28. Kolansky G, Green CK, Dubin H. Metastatic Crohn's disease of the face: an uncommon presentation. Arch Dermatol. 1993;129:1348-1349. 
  29. Mahadevan U, Sandborn WJ. Infliximab for the treatment of orofacial Crohn's disease. Inflamm Bowel Dis. 2001;7:38-42.
  30. McCallum DI, Gray WM. Metastatic Crohn's disease. Br J Dermatol. 1976;95:551-554.
  31. Lieberman TR, Greene JF Jr. Transient subcutaneous granulomatosis of the upper extremities in Crohn's disease. Am J Gastroenterol. 1979;72:89-91.
  32. Kafity AA, Pellegrini AE, Fromkes JJ. Metastatic Crohn's disease: a rare cutaneous manifestation. J Clin Gastroenterol. 1993;17:300-303.
  33. Marotta PJ, Reynolds RP. Metastatic Crohn's disease. Am J Gastroenterol. 1996;91:373-375.
  34. Hackzell-Bradley M, Hedblad MA, Stephansson EA. Metastatic Crohn's disease. report of 3 cases with special reference to histopathologic findings. Arch Dermatol. 1996;132:928-932.
  35. van Dulleman HM, de Jong E, Slors F, et al. Treatment of therapy resistant perineal metastatic Crohn's disease after proctectomy using anti-tumor necrosis factor chimeric monoclonal antibody, cA2: report of two cases. Dis Colon Rectum. 1998;41:98-102.
  36. Lavery HA, Pinkerton JH, Sloan J. Crohn's disease of the vulva--two further cases. Br J Dermatol. 1985;113:359-363.
  37. Lally MR, Orenstein SR, Cohen BA. Crohn's disease of the vulva in an 8-year-old girl. Pediatr Dermatol. 1988;5:103-106.
  38. Tuffnell D, Buchan PC. Crohn's disease of the vulva in childhood. Br J Clin Pract. 1991;45:159-160.
  39. Schrodt BJ, Callen JP. Metastatic Crohn's disease presenting as chronic perivulvar and perirectal ulcerations in an adolescent patient. Pediatrics. 1999;103:500-502.
  40. Slaney G, Muller S, Clay J, et al. Crohn's disease involving the penis. Gut. 1986;27:329-333.
  41. Calder CJ, Lacy D, Raafat F, et al. Crohn's disease with pulmonary involvement in a 3 year old boy. Gut. 1993;34:1636-1638.
  42. Saha S, Fichera A, Bales G, et al. Metastatic Crohn's disease of the bladder. Inflamm Bowel Dis. 2008;14:140-142.
  43. Escher JC, Stoof TJ, van Deventer SJ, et al. Successful treatment of metastatic Crohn disease with infliximab. J Pediatr Gastroenterol Nutr. 2002;34:420-423.
  44. Saadah OI, Oliver MR, Bines JE, et al. Anorectal strictures and genital Crohn's disease: an unusual clinical association. J Pediatr Gastroenterol Nutr. 2003;36:403-406.
  45. Martinez-Salamanca JI, Jara J, Miralles P, et al. Metastatic Crohn's disease: penile and scrotal involvement. Scand J Urol Nephrol. 2004;38:436-437.
  46. Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002;347:417-429.
  47. Acker SM, Sahn EE, Rogers HC, et al. Genital cutaneous Crohn disease. Am J Dermatopathol. 2000;22:443-446.
  48. Lestre S, Ramos J, Joao A, et al. Cutaneous Crohn's disease presenting as genital warts: successful treatment with adalimumab. Eur J Dermatol. 2010;20:504-505.
  49. Yu JT, Chong LY, Lee KC. Metastatic Crohn's disease in a Chinese girl. Hong Kong Med J. 2006;12:467-469.
  50. Wilson-Jones E, Winkelmann RK. Superficial granulomatous pyoderma: a localized vegetative form of pyoderma gangrenosum. J Am Acad Dermatol. 1988;18:511-521.
  51. Moyes LH, Glen P, Pickford IR. Perineal metastatic Crohn's disease: a case report and review of the literature. Ann R Coll Surg Engl. 2007;89:W1-W3.
  52. Rajpara SM, Siddha SK, Ormerod AD, et al. Cutaneous penile and perianal Crohn's disease treated with a combination of medical and surgical interventions. Australas J Dermatol. 2008;49:21-24.
  53. Cockburn AG, Krolikowski J, Balogh K, et al. Crohn disease of penile and scrotal skin. Urology. 1980;15:596-598.
  54. Guest GD, Fink RL. Metastatic Crohn's disease: case report of an unusual variant and review of the literature. Dis Colon Rectum. 2000;43:1764-1766.
  55. Sangueza OP, Davis LS, Gourdin FW. Metastatic Crohn disease. South Med J. 1997;90:897-900.
  56. Chiba M, Iizuka M, Horie Y, et al. Metastatic Crohn's disease involving the penis. J Gastroenterol. 1997;32:817-821.
  57. Poon KS, Gilks CB, Masterson JS. Metastatic Crohn's disease involving the genitalia. J Urol. 2002;167:2541-2542.
  58. Shanahan F. Anti-TNF therapy for Crohn's disease: a perspective (infliximab is not the drug we have been waiting for). Inflamm Bowel Dis. 2000;6:137-139.
  59. Carranza DC, Young L. Successful treatment of metastatic Crohn's disease with cyclosporine. J Drugs Dermatol. 2008;7:789-791.
  60. Bardazzi F, Guidetti MS, Passarini B, et al. Cyclosporine A in metastatic Crohn's disease. Acta Derm Venereol. 1995;75:324-325.
  61. Faubion WA Jr, Loftus EV Jr, Harmsen WS, et al. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology. 2001;121:255-260.
  62. Gelbmann CM, Rogler G, Gross V, et al. Prior bowel resections, perianal disease, and a high initial Crohn's disease activity index are associated with corticosteroid resistance in active Crohn's disease. Am J Gastroenterol. 2002;97:1438-1445.
  63. Thukral C, Travassos WJ, Peppercorn MA. The role of antibiotics in inflammatory bowel disease. Curr Treat Options Gastroenterol. 2005;8:223-228.
  64. Brandt LJ, Berstein LH, Boley SJ, et al. Metronidazole therapy for perineal Crohn's disease: a follow-up study. Gastroenterology. 1982;83:383-387.
  65. Lehrnbecher T, Kontny HU, Jeschke R. Metastatic Crohn's disease in a 9-year-old boy. J Pediatr Gastroenterol Nutr. 1999;28:321-323.
  66. Abide JM. Metastatic Crohn disease: clearance with metronidazole. J Am Acad Dermatol. 2011;64:448-449.
  67. Rispo A, Scarpa R, Di Girolamo E, et al. Infliximab in the treatment of extra-intestinal manifestations of Crohn's disease. Scand J Rheumatol. 2005;34:387-391.
  68. Kaufman I, Caspi D, Yeshurun D, et al. The effect of infliximab on extraintestinal manifestations of Crohn's disease. Rheumatol Int. 2005;25:406-410.
  69. Konrad A, Seibold F. Response of cutaneous Crohn's disease to infliximab and methotrexate. Dig Liver Dis. 2003;35:351-356.
  70. Miller AM, Elliott PR, Fink R, et al. Rapid response of severe refractory metastatic Crohn's disease to infliximab. J Gastroenterol Hepatol. 2001;16:940-942.
  71. Chuah JH, Kim DS, Allen C, et al. Metastatic Crohn's disease of the ear. Int J Otolaryngol. 2009;2009:871567.
  72. Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med. 1999;340:1398-1405.
  73. Petrolati A, Altavilla N, Cipolla R, et al. Cutaneous metastatic Crohn's disease responsive to infliximab. Am J Gastroenterol. 2009;104:1058.
  74. Hanauer SB, Sandborn WJ, Rutgeerts P, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn's disease: the CLASSIC-I trial. Gastroenterology. 2006;130:323-333.
  75. Cury DB, Moss A, Elias G, et al. Adalimumab for cutaneous metastatic Crohn's disease. Inflamm Bowel Dis. 2010;16:723-724.

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Sours: https://www.mdedge.com/dermatology/article/141599/dermatopathology/metastatic-crohn-disease-review-dermatologic
Crohn's Disease: Pathophysiology, Symptoms, Risk factors, Diagnosis and Treatments, Animation.

Metastatic Crohn's disease: a review and approach to therapy

J Am Acad Dermatol. 2014 Oct;71(4):804-13. doi: 10.1016/j.jaad.2014.04.002. Epub 2014 Jun 2.

Affiliations

  • 1 Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona. Electronic address: [email protected]
  • 2 Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona.
  • 3 Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona.

Abstract

Metastatic Crohn's disease (CD) is a rare cutaneous manifestation of CD that was first described nearly 50 years ago. Many subsequent reports have defined its most common clinical and histopathologic features. The pathogenesis underlying metastatic CD is unknown but various hypotheses exist. An established standard therapy is lacking. Owing to its rarity and nonspecific clinical presentation along with the diversity of inflammatory skin disorders that often complicate CD, the diagnosis of metastatic CD may be overlooked. This report highlights the salient features of this disorder to facilitate recognition and management of this rare dermatosis.

Keywords: cutaneous Crohn's disease; cutaneous manifestations of Crohn's disease; gastrointestinal disease; granulomatous inflammation; inflammatory bowel disease; metastatic Crohn's disease.

Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Biopsy, Needle
  • Crohn Disease / complications*
  • Crohn Disease / pathology*
  • Dermatologic Agents / therapeutic use
  • Erythema / drug therapy
  • Erythema / etiology
  • Erythema / pathology
  • Female
  • Granuloma / drug therapy
  • Granuloma / etiology
  • Granuloma / pathology
  • Humans
  • Immunohistochemistry
  • Male
  • Prognosis
  • Rare Diseases
  • Risk Assessment
  • Severity of Illness Index
  • Skin Diseases / drug therapy
  • Skin Diseases / etiology*
  • Skin Diseases / pathology*
  • Skin Ulcer / drug therapy
  • Skin Ulcer / etiology
  • Skin Ulcer / pathology

Substances

  • Adrenal Cortex Hormones
  • Dermatologic Agents
Sours: https://pubmed.ncbi.nlm.nih.gov/24888520/

Disease metastatic crohns

Metastatic Crohn disease pathology

HomeTopics A–ZMetastatic Crohn disease pathology

Author: Harriet Cheng BHB, MBChB, Department of Dermatology, Waikato Hospital, Hamilton, New Zealand; A/Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand, 2013.


Metastatic Crohn disease pathology — codes and concepts

Crohn disease patients may develop sterile granulomatous skin lesions at sites removed from the gastrointestinal tract This is known as metastatic Crohn disease (MCD). When it affects the skin, it is also called cutaneous Crohn disease. Clinically, MCD presents as a solitary or multiple nodules, plaques, ulcers, lichenoid lesions, or violaceousperifollicularpapules.

Histology of metastatic Crohn disease

Metastatic Crohn disease is characterised by a dermal granulomatous infiltrate composed of epithelioidhistiocytes (figures 1-5). There is an associated infiltrate which is mainly lymphocytic but may be rich in eosinophils. The granulomas may encroach on the epidermis (figure 1). Massive oedema may be seen (figure 2). Ulceration of the overlying epidermis is a common feature (figure 4).

Granulomatous vasculitis and necrosis may also be seen in metastatic Crohn disease.

Metastatic Crohn disease pathology

Differential diagnosis of metastatic Crohn disease

Sarcoidosis: This may be a very difficult distinction without clinical correlation. Granulomata of Crohn disease are frequently less well-defined (figure 5) than in sarcoidosis. Ulceration is less common in sarcoidosis. Eosinophils are less dense in sarcoidosis.

Mycobacterial infection: Special stains and culture are required to exclude mycobacterial infection.

Granulomatous cheilitis (orofacial granulomatosis): This condition may be histologically identical. Clinical features help to differentiate.

 

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References:

  • Emanuel PO, Phelps RG. Metastatic Crohn's disease: a histopathologic study of 12 cases. J Cutan Pathol. 2008 May;35(5):457-61.

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Crohn's Disease: Pathophysiology, Symptoms, Risk factors, Diagnosis and Treatments, Animation.

Crohn skin disease

Author: Vanessa Ngan, Staff Writer, 2003.


Crohn skin disease — codes and concepts

What is Crohn disease?

Crohn disease is an inflammatory bowel disease that involves inflammation of the small intestine. This can cause pain, fever, constipation, diarrhoea and weight loss. Extraintestinal features are common in Crohn disease and include arthritis, skin problems, inflammation in the eyes or mouth, gallstones and kidney stones. Crohn disease affects about 1 in 300 Europeans and has peak onset in the teens and 20s.

When granulomatouslesions of Crohn disease involve sites other than the gastrointestinal tract, the disease is termed metastatic Crohn disease.

What are the clinical features of cutaneous Crohn disease?

Skin involvement or cutaneous Crohn disease occurs in about 40% of patients with Crohn disease.

Extension of intestinal Crohn disease

Skin tags, swelling (oedema), fissures and abscesses around the perineal and perianal region are common in patients with Crohn disease. Painful vulval or scrotal fissures and ulceration may occur. See DermNet NZ's page on genital Crohn disease.

Metastatic Crohn disease

Metastatic granulomatous cutaneous Crohn disease may present as spots or plaques found on the trunk, arms and legs. Lesions tend to be asymmetrical and involve dermis and or subcutaneous tissue (panniculitis). They may be mildly itchy.

Cutaneous reactions to intestinal Crohn disease

In some cases, non-granulomatous skin disorders occur as a reaction to the intestinal disease. These include:

Occasionally, skin lesions may occur before any signs or symptoms of the intestinal disease.

Oral Crohn disease

Oral involvement occurs in 8-9% of Crohn disease and may include:

Skin complications of Crohn disease

Secondary skin eruptions

Crohn disease affecting the gut may lead to malnutrition. Iron deficiency and vitamin deficiencies may present as skin or oral ulceration, persistent infections or pellagra.

Drugs prescribed for Crohn disease may also lead to adverse effects on the skin (drug eruptions).

How is Crohn skin disease diagnosed?

Skin biopsy of the lesion is performed. The histopathological finding of non-caseatinggranulomas similar to those found in intestinal Crohn disease supports the diagnosis of Crohn skin disease. In patients with no intestinal disease whose skin biopsy shows non-caseating granulomas, a thorough gastrointestinal history and systemicwork-up should be performed.

The presence of anti-Saccharomyces cerevesiae (ASCA) antibodies in the blood are very suggestive of Crohn disease, with 60% sensitivity and 90% specificity.

* Granuloma on skin pathology

What is the treatment of Crohn skin disease?

Treatment for Crohn skin disease is palliative not curative.

Treatment of the intestinal manifestations usually improves the skin lesions. Treatment may include:

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References

Book: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications.

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