Crohn Disease — SCE Dermatology MCQ

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HardConnective Tissue & VasculitisCrohn DiseaseSCE Dermatology

A 31-year-old woman presents with painful erythematous papules and nodules at surgical scars and at sites of recent trauma. She has a known diagnosis of Crohn disease. Biopsy shows non-caseating granulomas in the dermis. What is the most likely cutaneous manifestation?

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Correct answer: D — Metastatic Crohn disease

Metastatic Crohn disease refers to granulomatous inflammation in the skin at sites discontinuous from the GI tract. Biopsy showing non-caseating granulomas in a patient with Crohn disease presenting at sites of trauma/scars (pathergy) supports this diagnosis. Pyoderma gangrenosum (also associated with Crohn) shows neutrophilic infiltrate, not granulomas. Erythema nodosum shows septal panniculitis. Cutaneous sarcoidosis also shows granulomas but is a separate condition from Crohn. Metastatic Crohn disease can affect the vulva, limbs, and face.

Reference: BAD 2019 Patient Information; BJD 2018