10.5826/dpc.1202a56
text/xml
2160-9381
1792
en
Sibel Ersoy-Evans
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Metastatic Crohn Disease with groin localization in an adult patient
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-05-02
2021-05-15
2022-05-02
2022-05-24
e2022056
Dermatol Pract Concept
Sibel Ersoy-Evans
2022/05/02
10.5826/dpc.1202a56
e2022056
Hacettepe University, School of Medicine, Department of Dermatology, Ankara, Turkey
2160-9381
en
e2022056
Palamaras I, El-Jabbour J, Pietropaolo N, et al. Metastatic Crohn's disease: a review. J Eur Acad Dermatol Venereol. 2008;22(9):1033-1043. DOI: 10.1111/j.1468-3083.2008.02741.x. PMID: 18573158..
Metastatic Crohn Disease with groin localization in an adult patient
https://dpcj.org/index.php/dpc/article/download/1792/1597
   Metastatic Crohn Disease with Groin Localization
                  in an Adult Patient
                                          Duygu Gulseren1, Sibel Ersoy-Evans1


1 Hacettepe University, School of Medicine, Department of Dermatology, Ankara, Turkey



Key words: metastatic Crohn disease, groin, adult, genital ulcers, granuloma
Citation: Gulseren D, Ersoy-Evans S. Metastatic Crohn’s Disease with Groin Localization in an Adult Patient.
Dermatol Pract Concept. 2022;12(2):e2022056. DOI: https://doi.org/10.5826/dpc.1202a56
Accepted: August 30, 2021; Published: April 2022
Copyright: ©2022 Gulseren et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: Both authors have contributed significantly to this publication.
Corresponding author: Duygu Gülseren, Hacettepe University, School of Medicine, Department of Dermatology, Sihhiye/Ankara, Ankara,
TR 06100. E-mail: duygu_gulsrn@hotmail.com




Introduction                                                            was initiated. Despite the lack of high-risk sexual behavior,
                                                                        doxycycline was empirically added to the patient antibiotic
Metastatic Crohn disease (MCD) is a rare skin manifesta-                regimen for lymphogranuloma venereum infection, but the
tion of Crohn disease (CD). MCD can develop on any cuta-                ulcer did not improve. A skin punch biopsy sample was
neous surface, but has a predilection for the genital region,           obtained from the edge of the ulcer and histopathological
especially in children [1]. Herein, we present an adult case of         analysis showed suppurative granulomatous inflammation.
MCD with groin localization, so as to highlight the fact that           Histological stains were negative for bacterial and fungal
this localization can easily be overlooked if patients do not           microorganisms. Following histopathological examination,
present with any gastrointestinal symptoms.                             cutaneous tuberculosis, deep fungal infection, tularemia, and
                                                                        syphilis, which can lead to granuloma formation, were ruled
                                                                        out via additional detailed tests, including skin culture, PCR,
Case Presentation
                                                                        and serological tests.
A 58-year-old male presented with a painful ulcer that had                     To assess the connection of the ulcer, fistulography was
appeared on his right groin 10 days earlier. He did not report          performed, which showed distribution of the radiocontrast
having any systemic diseases or systemic symptoms involv-               agent in several tracts between soft tissues. Abdominal com-
ing the gastrointestinal system. Upon dermatological exam-              puted tomography scan showed terminal ileitis and a fistula
ination there was a linear, 1.3 cm × 5 cm tender ulcer on his           extending to the skin, although the patient did not report
right groin. The ulcer was rather deep and extended to the              any gastrointestinal symptoms relating to the diagnosis of
subcutaneous tissue, forming a fistulous tract. A swab cul-             CD. Colonoscopy and colonoscopic biopsy were performed,
ture of the discharge showed Enterococcus faecalis, Entero-             and the findings were consistent with active colitis. Based
coccus faecium, Escherichia coli, and Klebsiella pneumoniae             on the clinical, radiological, colonoscopic, and histopatho-
growth; therefore, parenteral sulbactam-ampicillin therapy              logic findings, the patient was diagnosed with MCD. After



Research Letter | Dermatol Pract Concept. 2022;12(2):e2022056                                                                        1
                                                                 gastrointestinal symptoms, which delayed the diagnosis of
                                                                 MCD. Another challenging aspect of diagnosis is ulcer local-
                                                                 ization. Although the most common presentation of MCD in
                                                                 children is the genital region, the most common presentation
                                                                 in adults is the extremities. Genital localization is of partic-
                                                                 ular importance in sexually active adult patients, as it can
                                                                 mimic sexually transmitted diseases.



                                                                 Conclusions
                                                                 MCD is a rare cause of genital ulcers in adult patients and
                                                                 can present without gastrointestinal symptoms. Genital
Figure 1. Ulcer with incompletely healed fistula opening.
                                                                 ulcers with granuloma formation in adults should suggest
starting oral mesalazine, azathioprine, and prednisolone,        MCD, even in patients that do not report any gastrointesti-
the fistulous discharge decreased, but the ulcer did not heal    nal symptoms.
completely (Figure 1); consequently, fistulectomy and right
hemicolectomy were performed.
                                                                 References
Discussion                                                        1. Schneider SL, Foster K, Patel D, Shwayder T. Cutaneous man-
                                                                     ifestations of metastatic Crohn’s disease. Pediatr Derma-
                                                                     tol. 2018;35(5):566-574. DOI: 10.1111/pde.13565. PMID:
MCD is the least common dermatologic manifestation of
                                                                     29952016.
CD. In 70% of adult patients MCD lesions appear after the
                                                                  2. Palamaras I, El-Jabbour J, Pietropaolo N, et al. Metastatic Crohn’s
initial diagnosis of CD; therefore, its diagnosis can be chal-       disease: a review. J Eur Acad Dermatol Venereol. 2008;22(9):1033-
lenging in adults without active gastrointestinal symptoms           1043. DOI: 10.1111/j.1468-3083.2008.02741.x. PMID:
at presentation [2]. The presented patient did not have any          18573158.




2                                                                    Research Letter | Dermatol Pract Concept. 2022;12(2):e2022056
