Cutaneous penile and perianal Crohn's disease treated with a combination of medical and surgical interventions

Abstract

A 73-year-old man presented with fistulizing cutaneous Crohn's disease of the penis and perianal area without involvement of the gastrointestinal tract. The disease failed to respond to topical clobetasol propionate and oral cyclosporin and methotrexate. A combination treatment of minocycline, thalidomide and prednisolone brought the disease under control and induced remission. Surgery with excision and skin grafting were required to produce cure.

Metastatic Crohn’s disease of the penis: two cases

“…The age of patients with MCD has been reported in a range from childhood to elderly age [4,5]. Lymphoedematous disease appears to affect children and younger men, whereas fistulating disease is more associated with adults and the elderly [5,11].…”

“…Patients with phimosis have been found to have unsuspected foci of MCD at circumcision [8,9]. There are varied descriptions of nodules, plaques, fistulating disease, and severe lymphoedema [3][4][5][6][7][8][9]. MCD can precede, coincide with, or occur after the diagnosis of bowel disease [10,11].…”

Severe case of genital and perianal cutaneous Crohnʼs disease

“…Although perianal involvement occurs in nearly one-third of patients with CD, 1 and cutaneous involvement can be seen in 22%-44%, [2][3][4] genital manifestations are extremely rare. In males, genital CD typically presents as swelling or ulcerations 2,3 and can be an extension of perianal disease. 5 A gentleman recently presented with a severe case of genital CD.…”

“…2,3,6 Cutaneous involvement is more common when the colon is involved rather than the small intestine. 4,5 Genital CD can present in several different ways.…”

“…2 Genital MCD can be seen in both women and men and usually begins as a nonhealing ulcer but can present as a papule, a plaque, or swelling. [2][3][4]6 Interestingly, the severity of the cutaneous findings may not correlate with the severity of the bowel symptoms. 4 Severe refractory lesions including the entire peritoneum, inguinal region, and deforming the penile shaft rarely occur.…”