Metastatic Crohn's disease mimicking genital pyoderma gangrenosum in an HIV patient

The differential diagnosis of ulcerative genital lesions in patients with high risk sexual habits can be a challenge even for dermatologists. We present the case of a 27-year-old HIV-positive male with a history of recalcitrant genital ulcers. Microbiology studies were negative. A skin biopsy and a sample from a perineal fistula showed granulomatous infiltrates. The patient was treated with prednisone, metronidazole and aminosalicylates, showing complete resolution of the lesions in a few weeks. The clinical picture and histological findings are consistent with the diagnosis of cutaneous metastatic Crohn's disease. Although infrequent, metastatic Crohn's disease should be suspected in cases of recalcitrant ulcerative conditions, even in the absence of intestinal disease.