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.
Share Button
New comment
Comments
No comments for this article
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.
Related articles

Letter

Treatment with hyperbaric oxygen in a Crohn’s disease patient

DOI: 10.17235/reed.2024.10166/2023

Letter

Lung abscess in a non-compliant patient with Crohn’s disease

DOI: 10.17235/reed.2024.10140/2023

Letter

Coincidental oral lesions in Crohn’s disease

DOI: 10.17235/reed.2023.9992/2023

Letter

Duodenal stenosis surgical treatment in Crohn’s disease

DOI: 10.17235/reed.2023.9521/2023

Digestive Diseases Image

Peristomal cutaneous Crohn's disease by contiguity

DOI: 10.17235/reed.2022.8909/2022

Letter

Pneumatosis intestinalis in a pediatric patient

DOI: 10.17235/reed.2021.8482/2021

Letter

Anal neoplasia and perianal Crohn’s disease: myth or reality?

DOI: 10.17235/reed.2021.8317/2021

Letter

Crohn’s disease in patients treated with etanercept

DOI: 10.17235/reed.2019.6554/2019

Original

Mercaptopurine and inflammatory bowel disease: the other thiopurine

DOI: 10.17235/reed.2016.4546/2016

Letter to the Editor

Adnexal localization of Crohn’s disease and recurrent massive ovary cysts

DOI: 10.17235/reed.2016.4301/2016

Letter to the Editor

Crohn’s disease and Sweet’s syndrome: A debut together

DOI: 10.17235/reed.2015.3842/2015

Case Report

Ovarian involvement in Crohn´s disease: A rare complication

DOI: 10.17235/reed.2015.3764/2015

Original

Management of refractory esophageal stenosis in the pediatric age

DOI: 10.17235/reed.2016.3671/2015

Citation tools
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


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1255 visits.
This article has been downloaded 122 times.

Statistics from Dimensions


Statistics from Plum Analytics

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


Share
This article has been rated by 2 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology