A Rare Clinical Presentation of Metastatic Crohn's Disease

Abstract

A 31-year-old female with a history of systemic lupus erythematous, IgA nephropathy, and psoriasis presented with a one-month history of a painful, pruritic rash under the bilateral breasts and in the genital region. Cutaneous examination revealed a large, tender ulcer under the left breast with a shiny erythematous base and peripheral hypertrophic changes. Small ulcers were present on the bilateral inguinal folds, and the labia majora were edematous with multiple erythematous papules. Histological examination of the left breast revealed ulceration with granulomatous dermatitis, consistent with a diagnosis of metastatic Crohn's disease. Metastatic Crohn's disease is a rare cutaneous manifestation of Crohn's disease characterized by non-caseating granulomas in regions non-contiguous with the gastrointestinal tract. At the time of diagnosis, our patient reported no gastrointestinal symptoms aside from occasional blood-streaked stools from hemorrhoids. This case demonstrates the importance of considering the disease when a patient presents with intertriginous or genital lesions, even in the absence of systemic manifestations.

Keywords: crohn’s disease; cutaneous crohn’s disease; cutaneous manifestations of systemic disease; metastatic crohn’s disease.

Figure 1. Left inframammary fold

Large, 6-cm ulcer with a shiny, erythematous base.

Figure 2. Groin region

Edematous labia majora with multiple verrucous, erythematous papules, and a 1-cm ulcer on the left inguinal crease.

Figure 3. Intergluteal folds

Multiple erythematous, shiny papules with interspersed fissuring.