Non-fistulous Bladder Ulceration in Crohn's Disease: A Rare Extraintestinal Manifestation

Non-fistulous bladder ulceration is an extremely unusual extraintestinal manifestation of Crohn's disease (CD) with significant diagnostic and therapeutic challenges. We present a case of a 21-year-old male with ileocolonic CD, post-resection, who was admitted with repeated gross hematuria. Initial imaging (CT/MRI) revealed bladder wall thickening and an enterocolonic fistula, but no enterovesical communication. Cystoscopy revealed widespread mucosal erythema and ulceration, and histopathology was in keeping with chronic inflammation but not malignancy or granulomas. Multidisciplinary evaluation excluded malignancies and infections and led to a diagnosis of non-fistulous bladder ulceration associated with CD. Escalation of infliximab led to the resolution of hematuria and sustained remission at six-month follow-up. This case highlights the importance of recognition of atypical bladder involvement in CD patients with urinary symptoms, even in the absence of fistulas. Advanced imaging techniques, cystoscopy, and multidisciplinary cooperation are crucial for accurate diagnosis. Anti-tumor necrosis factor (TNF) therapy, particularly dose-intensified regimens, can effectively manage both intestinal and extraintestinal inflammation, suggesting the participation of shared immunopathogenic mechanisms. This review emphasizes the need for heightened clinical suspicion and multidisciplinary management to optimize outcomes in atypical CD-related complications.