Background Metastatic Crohn’s disease is a rare disorder characterized by various granulomatous skin lesions
that occur independently of gastrointestinal tract involvement. However, currently there is no standardized care
or specific treatment. Therapeutic approaches include immunosuppressive agents, such as corticosteroids, azathioprine,
and monoclonal antibodies targeting inflammatory cytokines like tumor necrosis factor (TNF).
Case presentation We present a case of a 29-year-old western European woman with significant blind ending
abdominal subcutaneous fistulas and abscesses, who sought evaluation in the dermatology department. Histological
examination revealed multiple epithelioid cell granulomas. There was no evidence of infectious or rheumatologic
diseases such as sarcoidosis. The tentative diagnosis was metastatic Crohn’s disease, which was not related to an intestinal
manifestation of the disease. The patient responded to infliximab but had to discontinue it due to an allergic
reaction. Subsequent adalimumab treatment failed to induce clinical remission; thus, therapy was switched to ustekinumab,
resulting in a positive response. Written informed consent for publication of their clinical details and clinical
images was obtained from the patient.
For our study more than 1600 publications were screened for cases of metastatic Crohn’s disease on PubMed database.
59 case reports with 171 patients were included in the analysis and evaluated for localization, diagnostic
and therapeutic approaches, and complications and were summarized in this review.
Conclusion The successful ustekinumab treatment of a patient with metastatic Crohn’s disease underscores
the potential of this minimally investigated therapeutic option, highlighting the need for future treatment guidelines
given the increasing prevalence of such cases.