Introduction: Crohn’s disease is an autoimmune inflammatory disorder affecting the gastrointestinal tract. Rarely, Crohn’s disease can cause cutaneous manifestations that are non-contiguous with the GI tract or “metastatic.” Genital Cutaneous Crohn’s Disease (CCD) is the most frequent presentation of CCD in the pediatric population and has shown to be difficult to manage. Case: A 13-year-old boy with a history of fistulizing Crohn’s disease presented with severe penile and scrotal edema for the previous 4 years. While his gastrointestinal symptoms were responsive to Adalimumab, his genital swelling only minimally and temporarily improved between treatments. He was referred to pediatric urology for an excisional biopsy which revealed dermal fibrosis, perilymphatic inflammatory infiltrate composed of lymphocytes, plasma cells, and histiocytes. Additionally, poorly formed granulomas of histiocytes and multinucleated giant cells were identified. The scrotal and penile biopsies were both compatible with the diagnosis of metastatic Crohn’s disease. Conclusion: We describe a rare case of genital CCD in a patient with well controlled Crohn’s. After the positive biopsy, the patient began Azathioprine and Adalimumab combination therapy with substantial improvement in genital swelling. Although there are no treatment guidelines for CCD, literature suggests combination systemic therapy with immunomodulators to be the most beneficial. We highlight treatment options.
Shetty Z, Schober M. Metastatic Crohn's disease: a case of genital cutaneous Crohn's disease involving the penis and scrotum. Paper presented at: The 95th Annual Meeting of the North Central Section of the AUA; 2021 Oct 6-9; Chicago, IL. Available at: https://ncsaua.org/docs/meetings/ncs2110/ncs-2021-program-book.aspx