Metastatic cutaneous Crohn’s disease as an important differential diagnosis of granulomatous skin disease

Gabriela M Quadros,Murilo C Peretti,Gabriel S Reis,Maira M Mukai,Andressa T Szczypkovski,Heda Maria B S Amarante,Betina Werner

doi:10.5935/1676-2444.20160013

Gabriela M Quadros, Murilo C Peretti + Show 5 more

Open Access

https://doi.org/10.5935/1676-2444.20160013

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Abstract

Patients with Crohn's disease may show extraintestinal manifestations, including cutaneous, whose frequency ranges from 2% to 34%. Metastatic cutaneous Crohn's disease is considered a specific and rare manifestation, since the histopathology reveals granulomatous pattern with the same characteristics of the underlying bowel condition. The objective of this study is to report two cases of metastatic cutaneous Crohn's disease confirmed by histopathologic analysis, after excluding other granulomatous skin diseases. Case 1: Adult woman with pruritic erythematous scaly plaques disseminated on the upper limbs. Case 2: Adult man with grayish hyperchromic plaque infiltrated on the left buttock.

Highlights

Inflammatory bowel disease is an idiopathic and inflammatory condition of the intestinal tract, represented by Crohn’s disease and ulcerative colitis
The prevalence of extraintestinal manifestations in inflammatory bowel diseases ranges from 25% to 40%, and the skin involvement is present in 2% to 34% of patients[2]
The metastatic Crohn’s disease is considered an uncommon manifestation of the disease, as it is characterized by granulomatous skin lesions with the same histological characteristics of the underlying bowel disease[3]

Summary

Introduction

Inflammatory bowel disease is an idiopathic and inflammatory condition of the intestinal tract, represented by Crohn’s disease and ulcerative colitis. The sick gastrointestinal mucosa would cause immune response in the extraintestinal environment, such as the skin, through epitopes common to the bowel and the skin. Abnormal T cell response to microbial antigens may disturb this balance, causing chronic inflammation and excessive release of cytokines, resulting in inflammatory bowel disease. The cutaneous manifestations could be explained by the T cells of the intestinal mucosa that, in an aberrant way, move to the skin becoming exposed to cutaneous antigens and, causing skin changes. Inflammatory bowel disease should be considered a systemic disease not limited to the gastrointestinal tract, since many patients develop extraintestinal symptoms, such as cutaneous, with potential detrimental impact on the functional status and quality of life of the patient[4]

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