Penoscrotal swelling as a presentation of Crohn's disease

Metastatic Crohn's disease (MCD) is a rare extraintestinal manifestation of Crohn's disease (CD), particularly in pediatric patients. It refers to cutaneous involvement at areas distant and non-contiguous from the bowel. We present a boy with a 1.5-year history of perianal lesions, penoscrotal swelling, and intermittent hematochezia. Examination revealed hepatosplenomegaly, perianal erythematous plaques, and inguinoscrotal swelling. Biopsy of the scrotal skin revealed non-caseating granulomatous inflammation, suggestive of MCD. Stool calprotectin was elevated, however, gastrointestinal biopsies were suggestive of indeterminate colitis. Initial management with symptomatic treatment provided limited relief, and he was later started on oral immunomodulators. This case highlights MCD as a rare but significant initial presentation of CD in pediatric patients and emphasizes the need for increased awareness of MCD in children with unexplained cutaneous lesions.