Abstract:Metastatic Crohn’s disease is a rare extraintestinal manifestation of Crohn’s
disease. It is characterized by polymorphic skin lesions formed by non-caseating
granulomas located on anatomical sites distant from the gastrointestinal tract.
We report a rare case of metastatic Crohn’s disease, simultaneously displaying
multiple clinically heterogeneous cutaneous lesions, in a patient with
previously diagnosed Crohn’s disease in remission due to anti-TNF-α use.
This case highlights the need for high clinical suspi… Show more
“…Notably, our case report highlights that metastatic Crohn’s disease can affect almost every part of the body. This is in accordance with other reports describing affected skin at various sites of the body including extremities, trunk or head/face [ 4 , 5 , 16 , 22 , 25 , 30 – 32 , 36 – 38 , 41 , 44 , 47 , 48 ]. Fig.…”
Background
Metastatic Crohn’s disease is a rare disorder characterized by various granulomatous skin lesions that occur independently of gastrointestinal tract involvement. However, currently there is no standardized care or specific treatment. Therapeutic approaches include immunosuppressive agents, such as corticosteroids, azathioprine, and monoclonal antibodies targeting inflammatory cytokines like tumor necrosis factor (TNF).
Case presentation
We present a case of a 29-year-old western European woman with significant blind ending abdominal subcutaneous fistulas and abscesses, who sought evaluation in the dermatology department. Histological examination revealed multiple epithelioid cell granulomas. There was no evidence of infectious or rheumatologic diseases such as sarcoidosis. The tentative diagnosis was metastatic Crohn’s disease, which was not related to an intestinal manifestation of the disease. The patient responded to infliximab but had to discontinue it due to an allergic reaction. Subsequent adalimumab treatment failed to induce clinical remission; thus, therapy was switched to ustekinumab, resulting in a positive response. Written informed consent for publication of their clinical details and clinical images was obtained from the patient.
For our study more than 1600 publications were screened for cases of metastatic Crohn’s disease on PubMed database. 59 case reports with 171 patients were included in the analysis and evaluated for localization, diagnostic and therapeutic approaches, and complications and were summarized in this review.
Conclusion
The successful ustekinumab treatment of a patient with metastatic Crohn's disease underscores the potential of this minimally investigated therapeutic option, highlighting the need for future treatment guidelines given the increasing prevalence of such cases.
“…Notably, our case report highlights that metastatic Crohn’s disease can affect almost every part of the body. This is in accordance with other reports describing affected skin at various sites of the body including extremities, trunk or head/face [ 4 , 5 , 16 , 22 , 25 , 30 – 32 , 36 – 38 , 41 , 44 , 47 , 48 ]. Fig.…”
Background
Metastatic Crohn’s disease is a rare disorder characterized by various granulomatous skin lesions that occur independently of gastrointestinal tract involvement. However, currently there is no standardized care or specific treatment. Therapeutic approaches include immunosuppressive agents, such as corticosteroids, azathioprine, and monoclonal antibodies targeting inflammatory cytokines like tumor necrosis factor (TNF).
Case presentation
We present a case of a 29-year-old western European woman with significant blind ending abdominal subcutaneous fistulas and abscesses, who sought evaluation in the dermatology department. Histological examination revealed multiple epithelioid cell granulomas. There was no evidence of infectious or rheumatologic diseases such as sarcoidosis. The tentative diagnosis was metastatic Crohn’s disease, which was not related to an intestinal manifestation of the disease. The patient responded to infliximab but had to discontinue it due to an allergic reaction. Subsequent adalimumab treatment failed to induce clinical remission; thus, therapy was switched to ustekinumab, resulting in a positive response. Written informed consent for publication of their clinical details and clinical images was obtained from the patient.
For our study more than 1600 publications were screened for cases of metastatic Crohn’s disease on PubMed database. 59 case reports with 171 patients were included in the analysis and evaluated for localization, diagnostic and therapeutic approaches, and complications and were summarized in this review.
Conclusion
The successful ustekinumab treatment of a patient with metastatic Crohn's disease underscores the potential of this minimally investigated therapeutic option, highlighting the need for future treatment guidelines given the increasing prevalence of such cases.
“…Se ha sugerido que la reacción granulomatosa a distancia puede ser efecto del depósito de inmunocomplejos del tracto gastrointestinal en la piel. Otros autores apoyan la teoría de la reactividad cruzada entre antígenos de estos dos orígenes 5,6 . En enfermos con este padecimiento, en particular en aquéllos con manifestaciones extraintestinales, pueden encontrarse complejos inmunitarios inespecíficos circulantes en sangre 6 .…”
Section: Discussionunclassified
“…Por el contrario, el paciente comunicado desarrolló ECC a pesar de la enfermedad intestinal estable en tratamiento con adalimumab. Algunos especialistas sugieren que esto podría deberse a los valores séricos bajos del anticuerpo anti-TNF-α o a la formación de anticuerpos contra éste, lo que reduce potencialmente su eficacia terapéutica 5 . No obstante, estos métodos de cuantificación no se encuentran disponibles en la institución.…”
afección en la piel. Caso clínico: Varón de 43 años de edad que presentaba una úlcera en el glúteo izquierdo, asintomática, de cuatro meses de evolución. Tenía como antecedente enfermedad de Crohn ileal de fenotipo estenosante, tratado con adalimumab desde dos años antes, sin actividad al momento de la consulta. La histopatología reveló granulomas confluentes sin caseosis central. Las técnicas de Ziehl Neelsen y PAS resultaron negativas. No hubo desarrollo de bacterias, micobacterias u hongos en los cultivos. Con el antecedente de enfermedad inflamatoria intestinal, la clínica y los estudios complementarios se confirmó el diagnóstico de enfermedad de Crohn cutánea. Conclusión: Se comunica un caso infrecuente de enfermedad de Crohn cutánea, debido a su aparición en un paciente con enfermedad de Crohn intestinal estable tratado con adalimumab. Además, debido a la presentación clínica inicial en forma de pústula y su posterior evolución a úlcera, es importante distinguirlo del pioderma gangrenoso.
“…Specific alterations are caused by continuity such as oral ulcers, abscesses, fissures, and perianal or peristomal fistulas; or by metastatic Crohn’s disease (mCD), which can produce papules, erythematous infiltrated plaques, nodules or ulcers, distant from the original sites of disease involvement, with or without local pain. 16 , 17 , 18 , 19 …”
Section: Gastrointestinal Diseasesmentioning
confidence: 99%
“…It affects both sexes equally and often affects the perineal region with edema, erythema, and fissures. 19 …”
The skin, by reflecting internal processes, externalizes what happens inside the body in many diseases. Thus, the skin, as an organ, extrapolates its functions of protection, barrier and signals the existence of systemic diseases, expanding the importance of the dermatologist beyond the skin surface. Thus, the dermatologist investigates diagnostic hypotheses for conditions related to all systems and refers patients to the appropriate specialty. Combined with examination by a trained eye, the skin, due to its easy access, is still the ideal place for performing biopsies, which often clarify the diagnosis. This manuscript is the second part of the article on cutaneous manifestations of systemic diseases. In the first part, the cutaneous manifestations of the main rheumatologic and granulomatous diseases were described, and vascular manifestations were also addressed. In the present article, it will be discussed how metabolic, cardiovascular, kidney, and gastrointestinal diseases can manifest themselves in the integumentary system. Malignant diseases and their cutaneous implications, will also be discussed. Pruritus and its clinical cutaneous correspondence will be discussed. Finally, an update on cutaneous signs of SARS-CoV2 coronavirus infection will be presented.
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