Unusual appearance of Crohn's disease

W. M. Ramsdell, R. J. Shulman and C. H. Lifschitz

The association of perianal fistulas and Crohn's disease is well recognized. The appearance of lesions distant from the anal area is, however, uncommon. A young girl appeared with a history of weight loss and extensive mucocutaneous ulcerations. Diarrhea subsequently developed. Colonoscopy revealed friability, edema, and ulcerations. A crypt abscess was found in colonic biopsy specimens. Treatment with prednisolone acetate and sulfasalazine resulted in prompt improvement. A skin biopsy done initially and repeated colon biopsy three months later demonstrated granulomas, consistent with Crohn's disease. The literature regarding skin lesions in association with Crohn's disease is reviewed and the importance of recognizing the cutaneous manifestations of Crohn's disease is emphasized.