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Published on: December 15, 2011
Infantile Crohn disease presenting with diarrhea and pyoderma gangrenosum
James G H Dinulos1, Gary L Darmstadt, Mary K Len
1Department of Medicine and Pediatrics (Dermatology), Dartmouth-Hitchcock Clinic, Dartmouth Medical School, Lebanon, New Hampshire, USA. james.g.h.dinulos@hitchcock.org
Insights
Infantile Crohn disease can present with skin ulcers mimicking local irritation. Early diagnosis through cutaneous signs is crucial for infants with chronic diarrhea and rash, improving outcomes.
Area of Science:
- Pediatric Gastroenterology
- Dermatology
- Systemic Inflammatory Diseases
Background:
- Diaper area erosions are common in infants, often attributed to local irritation.
- Chronic diarrhea and failure to thrive in infants can be associated with various underlying conditions.
Observation:
- An infant presented with extensive ulcerations in the inguinal folds and perineum, initially presumed to be due to local irritation.
- Cutaneous examination revealed signs suggestive of pyoderma gangrenosum.
Findings:
- The infant was diagnosed with infantile Crohn disease, a rare inflammatory bowel disease.
- Pyoderma gangrenosum was identified as a cutaneous manifestation of infantile Crohn disease.
Implications:
- Cutaneous signs in infants with chronic diarrhea and rash can indicate underlying systemic diseases.
- Prompt diagnosis of infantile Crohn disease is vital, as it often requires surgical intervention and carries significant mortality risk.
- This case highlights the importance of considering systemic conditions when evaluating infant skin lesions.
Abstract:
Cutaneous erosions and ulcerations in the diaper area are common in infancy and usually result from local irritation. We describe an infant with chronic diarrhea and failure to thrive who developed extensive ulcerations in the inguinal folds and perineum that were initially thought to be exclusively caused by local irritation. A cutaneous examination found signs consistent with those of pyoderma gangrenosum, leading to a diagnosis of infantile Crohn disease. Cutaneous signs can lead to the diagnosis of an underlying systemic disease in infants with chronic diarrhea and rash. Prompt diagnosis is especially important in infantile Crohn disease, since many infants require surgical resection of affected bowel, and 60% die from disease complications. This article reports a rare instance of an infant who developed pyoderma gangrenosum due to Crohn disease and reviews cutaneous signs of systemic disease in infants presenting with chronic diarrhea and rash.
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