[Metastatic Crohn's disease in childhood]

Area of Science:

• Gastroenterology
• Dermatology
• Pediatrics

Background:

• Crohn's disease (CD) is a chronic inflammatory bowel disease with variable extraintestinal manifestations.
• Cutaneous involvement in CD is common but typically nonspecific or directly contiguous with inflamed bowel.
• Metastatic Crohn's disease, characterized by granulomatous skin lesions distant from the gastrointestinal tract, is exceptionally rare.

Observation:

• A 9-year-old boy with known ileocolonic and perianal CD presented with isolated penile and scrotal swelling.
• Clinical examination revealed scrotal wall thickening and increased vascular flux on ultrasound.
• Skin biopsy confirmed noncaseating granulomas, excluding infectious etiologies.

Findings:

• The patient was diagnosed with metastatic Crohn's disease affecting the genital region.
• Treatment escalation with increased prednisone dosage and addition of metronidazole led to significant clinical improvement.
• Lesions recurred upon prednisone dose reduction, necessitating ongoing maintenance therapy.

Implications:

• This case underscores the importance of considering metastatic Crohn's disease in pediatric patients with unexplained genital swelling, even with a prior CD diagnosis.
• Early recognition and appropriate management, including immunosuppression and antibiotics, are crucial for controlling rare cutaneous manifestations of CD.
• Further research into the pathogenesis and optimal treatment strategies for metastatic Crohn's disease is warranted.