Metastatic Crohn's disease despite infliximab therapy

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 suspicion and early biopsy in the setting of a patient with Crohn's disease and persistent skin lesions, even under biologic therapy. Furthermore, it reinforces the need of monitoring of the serum level of infliximab, increasing the dose in case it is low or undetectable.

Figure 1

Erythematous, erosive, crusty and painful plaques on the occipital and post-auricular regions

Figure 2

iII-defined scaly plaques on the left axilla

Figure 3

Edema of the vulva and mons pubis, followed by ill-defined erythema and scaling

Figure 4

A. The histology of the post-auricular lesion reveals granulomatous infiltration occupying the whole dermis. There is mild focal parakeratosis, acanthosis and spongiosis of the overlying epidermis (Hematoxylin & eosin, X40). B. iII-defined granuloma with histiocytes, some multinucleated giant cells, lymphocytes and plasma cells (Hematoxylin & eosin, X200)