Year 2016 / Volume 108 / Number 9
Case Report
Metastatic Crohn’s disease in pediatrics

598-603

DOI: 10.17235/reed.2016.3948/2015

Javier Blasco Alonso, Francisco Girón Fernández-Crehuet, Miguel A. Lendínez Ramírez, Sivia Gallego Gutiérrez, Silvia Luque Pérez, Juliana Serrano Nieto, Víctor M. Navas López, Carlos Sierra Salinas,

Abstract
Introduction and objectives: Metastatic Crohn’s disease (MCD) is an extraintestinal manifestation of Crohn’s disease, with biopsy as fundamental diagnostic tool. There are few references to MCD in children, with a 0.5-1% estimated incidence in adults. There is no consensus about its therapeutic approach. We describe our diagnostic and therapeutic experience in MCD. Results: Four cases of MCD are described in our Pediatric Gastroenterology Unit in a tertiary care hospital. The age at diagnosis was between 7 and 13 years. Lesions appeared before the diagnosis of Crohn’s disease in three of them, and during the course of the disease in another one, with genital location in three patients and bilateral pretibial region in the other. All four cases demonstrated non-caseificant granulomas on biopsy. Only two patients used exclusive enteral nutrition therapy with complete resolution, while other two cases received a combination of therapies (corticosteroids, azathioprine, tacrolimus, infliximab and adalimumab) because of recurrence. Only one case required surgery after poor clinical control. Conclusion: The MCD is infrequent but must always be included in the differential diagnosis of cutaneous lesions in Crohn’s disease, considering it could be the debut of the disease. We will rely on biopsy anyway for definitive diagnosis. In this series the genital region is verified as the most commonly affected in children. The therapeutic approach does not differ from the management of intestinal involvement.
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References
1.- Dotson JL, Hyams JS, Markowitz J, et al. Extraintestinal manifestations of pediatric inflammatory bowel disease and their relation to disease type and severity. J Pediatr Gastroenterol Nutr 2010;51:140-5.
2.- Jose FA, Garnett EA, Vittinghoff E, et al. Development of extraintestinal manifestations in pediatric patients with inflammatory bowel disease. Inflamm Bowel Disease 2009;15:63-8.
3.- Parks AG, Morson BC, Pegum JS. Crohn´s disease with cutaneous involvement. Proc R Soc Med 1965;58: 241-2.
4.- González Gómez JM, Sierra Salinas C, Alonso Usabiaga I, et al. Metastatic Crohn´s disease in childhood. An Esp Pediatr. 2001;55:165-8.
5.- Sierra C, Barco A, Del Río L. Treatment of metastatic Crohn´s disease. J Pediatr Gastroenterol Nutr 2002;35:708.
6.- Palamaras I, El-Jabbour J, Pietropaolo N, et al. Metastatic Crohn´s disease: a review. J Eur Acad Dermatol Venereol 2008;22:1033-43.
7.- Keiler S, Tyson P, Tamburro J. Metastatic cutaneous Crohn's disease in children: case report and review of the literature. Pediatr Dermatol 2009;26:604-9.
8.- Romero Gutiérrez M, Alcántara Torres M, Muñoz Rosas C, et al. Metastatic Crohn's disease. Gastroenterol Hepatol 2010;33:440-4
9.- Tatnall FM, Dodd HJ, Sarkany I. Crohn's disease with metastatic cutaneous involvement and granulomatous cheilitis. J R Soc Med 1987;80: 49-51
10.- Nabatian AS, Shah KN, Iofel E, et al. Asymptomatic granulomatous vulvitis and granulomatous cheilitis in childhood: The need for Crohn´s disease workup. J Pediatr Gastroenterol Nutr 2011;53:100-1.
11.- Martín de Carpi J, Chaves K, Vicente MA, et al. Manifestaciones cutáneas de la enfermedad inflamatoria intestinal. An Esp Pediatr 2009;70:570-7.
12.- Gilson RT, Elston D, Pruitt A. Metastatic Crohn´s disease: remission induced by mesalamine and prednisone. J Am Acad Dermatol 1999; 41:476-9.
13.- Albuquerque A, Magro F, Rodrigues S, et al. Metastatic cutaneous Crohn's disease of the face: a case report and review of theliterature. Eur J Gastroenterol Hepatol 2011;23:954-6.
14.- Kugathasan S, Miranda A, Nocton J, et al. Dermatologic manifestations of Crohn disease in children: responde a infliximab. J Pediatr Gastroenterol Nutr 2003;37:150-4.
15.- Marzano AV, Borghi A, Stadnicki A, et al. Cutaneous manifestations in patients with inflammatory bowel diseases: Pathophysiology, clinical features, and therapy. Inflamm Bowel Diseases 2014;20:213-27.
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Blasco Alonso J, Girón Fernández-Crehuet F, Lendínez Ramírez M, Gallego Gutiérrez S, Luque Pérez S, Serrano Nieto J, et all. Metastatic Crohn’s disease in pediatrics. 3948/2015


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Publication history

Received: 29/07/2015

Accepted: 01/08/2015

Online First: 09/02/2016

Published: 06/09/2016

Article revision time: 2 days

Article Online First time: 195 days

Article editing time: 405 days


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