Metastatic Crohn’s Disease in a Patient in Deep Remission
AIBD 2023
Background:
Metastatic Crohn’s disease (MCD), defined as skin lesions present in areas noncontiguous with the gastrointestinal tract, is the rarest cutaneous manifestation of Crohn’s disease. MCD lesions vary in morphology and can arise anywhere on the skin.
Methods:
A case report Crohn metastatic in a patient in deep remission.
Results:
F.H.C.M, male, 25 years, with colonic Crohn’s disease since 2018, with diarrhea with mucus and blood, abdominal pain, weight loss, urgency and tenesmus. A colonoscopy was performed which showed pancolitis – Mayo 3 (chronic colitis biopsies). Treatment was started with sulfasalazine 3 g/d without improvement, and azathioprine was subsequently associated n without remission. He remained without treatment during the pandemic and resumed outpatient follow-up in 2021. It was decided to start the immunobiological drug infliximab in November 2021 with significant clinical improvement. In March 2023, erythematous plaques appeared in the pre-tibial region, which evolved into extensive ulcerated lesions. During this period he underwent a colonoscopy which did not show disease activity - Mayo 0 (no colitis). Due to the worsening of the lesions in the lower limbs, a biopsy was performed which revealed a non-caseating granuloma in the dermis, compatible with MCD. Corticosteroids were then started and the dose of infliximab was optimized to 10 mg/kg.
Conclusions:
MCD is rare, being an extra-intestinal manifestation that can appear simultaneously or after the intestinal condition. It occurs mainly when there is colonic involvement and is generally not related to disease activity. The etiology is still uncertain, it is believed to be immunological in nature. The most common location: legs and arms (38%), being rarer in the genital region and face (15%). It is more common in women (63%), with pleomorphic lesions (nodules, ulcerations, erythematous plaques) whose biopsy shows non-caseating granuloma, with giant cells, plasma cells and lymphocytes in the dermis. Biopsy is important to rule out infectious diseases: fungi and mycobacteria. Treatment: uncertain - depends on location, severity and association with systemic disease. Treatment is not yet well established, with immunosuppressants, immunobiologicals, oral and topical corticosteroids, topical tacrolimus and even surgery being used in refractory cases. Thorough investigation is essential for the correct diagnosis of the disease, as it can be confused with other diseases. You should always have an evaluation by a dermatologist. Early diagnosis helps in correct treatment and in minimizing the aesthetic and functional damage caused by the disease, improving the patient’s quality of life.
