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Skin lesion in Crohn's Disease (Non-Caseating Granulomatous Inflammation)

Dr Sampurna Roy MD

Dermatopathology Case 127:

Diagnosis: Cutaneous Lesion in Crohn's Disease

 

                                                                                                                      

 

Crohn's disease is a chronic inflammatory bowel disease which may have distinctive mucocutaneous manifestations.

The classic pathology of skin disease discontinuous from the inflamed gastrointestinal tract in patients with Crohn's disease includes pyoderma gangrenosum, Sweet’s syndrome, hidradenitis suppurativa, erythema nodosum , and so-called metastatic Crohn's disease.

All the lesions are characterized by neutrophils.

Perianal lesion includes skin tags, fistulas and abscesses.

Cheilitis granulomatosa may occur on the lips. (Melkersson Rosenthal Syndrome )

Cutaneous "metastatic Crohn's disease" is a granulomatous inflammation of the skin that is noncontiguous to the gastrointestinal tract.

Age:  Usually young adults.

Sex: Both male and female with slight predominance of women. 

Clinically, the lesions present as vesiculopustules and painful erythematous nodules.

Site: In metastatic Crohn's disease the lesions may occur on the following sites:

(1) Intertriginous area

(2) Limbs

(3) Rarely vulva, scrotum and penis (Common in children).

(4) Head and neck

The lesions may ulcerate and later heal leaving a scar.

Microscopic features:

Non-caseating granulomas are present in the reticular dermis and subcutis. 

 

Granulomas may have a perivascular distribution.

Lymphocytes may be present in the wall of medium-sized vessels situated at the junction of the dermis and the subcutaneous fat.

Perivascular and sometimes periadnexal lymphocytic  infiltrate may be noted.

Other features: Presence of "Vesiculopustules" characterized by presence of neutrophils in large numbers in one or more infundibula, as well as in the upper part of the dermis.

Patchy infiltrates of neutrophils may be present in lobules in the subcutaneous fat.

There may be thromboembolic phenomena and features of cutaneous vasculitis.

 

Further reading:

Crohn's disease of the vulva.

Metastatic Crohn's disease accompanying granulomatous vasculitis and lymphangitis in the vulva.

Cutaneous manifestations in patients with inflammatory bowel diseases: pathophysiology, clinical features, and therapy.

Metastatic Crohn disease: a rare cutaneous entity.

Metastatic cutaneous Crohn's disease of the face: a case report and review of the literature.

Metastatic Crohn's disease.

Metastatic cutaneous Crohn's disease in children: case report and review of the literature.

Metastatic Crohn's disease: two cases of penile Crohn's and literature review.

Metastatic Crohn's disease: manifestation in head and neck region.

41-year-old patient with dermal changes on both lower legs. Cutaneous metastatic Crohn disease.

 

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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