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A 68-year-old woman presented to the hospital with acute left-sided abdominal pain. Six months prior to admission she developed watery diarrhea up to 8 bowel movements daily, and she reported over 70 pounds of weight loss. On examination she had a painful 20 cm ulcer within her intergluteal fold extending toward the anus (Figure 1). She had similar lesions in her intertriginous areas under her breasts and abdominal pannus (Figures 2 and 3). Punch biopsy of the ulcer showed non-caseating granulomas and was negative for mycobacterial or fungal organisms. Colonic mucosal biopsies from lower endoscopy and serologic testing were consistent with a diagnosis of metastatic Crohn’s disease (MCD) (Figure 4). The patient was started on mesalamine 1000 mg by mouth four times daily, prednisone 20 mg twice daily, and triamcinolone 0.1% topical ointment twice a day. She was seen in clinic two months after hospital discharge and reported significant improvement of both her gastrointestinal (GI) symptoms and cutaneous ulcerative lesions.

Metastatic Crohn’s disease: A case of a rarer IBD-related entity at initial presentation