S2464 An Unusual Case of Metastatic Crohn’s Disease Without Gastrointestinal Symptoms

Abstract

Introduction: Metastatic Crohn’s disease (MCD) is the least common cutaneous manifestation and is often misdiagnosed. Here, we present a case of severe MCD in the absence of active gastrointestinal symptoms, initially diagnosed as hidradenitis suppurativa, unresponsive to multiple courses of antibiotics before the appropriate treatment was initiated. Case Description/Methods: A 43-year-old female with a 7-year history of Crohn’s disease was admitted for evaluation of worsening skin lesions in the axillary (Figure 1) and inguinal areas. She was diagnosed with hidradenitis suppurativa 6 months prior and completed multiple courses of antibiotics; however, her conditioned progressed. On exam, the lesions were numerous, nodular, tender, with serous drainage. Biopsy of the lesions demonstrated noncaseating epithelioid granulomas, multinucleated giant cells, and perinuclear cuffing with lymphoplasmacytic infiltrates. A diagnosis of MCD was made, and she was started on infliximab and oral steroid taper. At 3-month follow-up, she had complete resolution, and her Crohn’s disease remained in remission. Discussion: MCD is a rare entity with significant morbidity that can mimic other conditions clinically and histopathologically, leading to the potential for misdiagnosis. These lesions can precede the diagnosis of Crohn’s disease in ∼25% of cases. There are no guidelines or trials to guide treatment; however, anecdotal evidence of response to infliximab has been reported. This case illustrates the diagnostic challenge of metastatic Crohn’s disease, especially in the absence of gastrointestinal symptom and the importance of its recognition for early treatment.Figure 1.: Axillary lesions.