An unusual cutaneous manifestation of Crohn's disease

Crohn's disease is a multisystem disease that involves the skin in approximately 20% of afflicted individuals. Most often, it is characterized by an erythema nodosum-like reaction or by a fistulous tract in skin adjacent to mucosal membranes. We recently saw a patient who presented with crusted malar plaques and a long-standing history of Crohn's disease. The skin lesions relapsed and recurred in concert with exacerbations of the gastrointestinal disorder. On biopsy, the sections showed a diffuse neutrophilic inflammatory infiltrate. There was no evidence of a granulomatous infiltrate on step sections through the block. We believe this to be a previously unrecognized pattern of Crohn's disease involving the skin.