P-018 Metastatic Crohn’s Disease in the Advanced Elderly and Response to Biologic Therapy—A Case Report

Abstract

BACKGROUND: Crohn's Disease has a broad range of extra-intestinal manifestations. Granulomatous non-fistulated skin ulcers is a rare manifestation of Crohn's disease especially in the advanced elderly. METHOD(S): We describe the case of an elderly 93 year old male who was diagnosed with Crohn's ileitis through screening colonoscopy in 2006 and confirmed by CT scan of the abdomen and pelvis which revealed 18 inch segment of ileitis. His only symptom was occasional mild right lower quadrant pain which never required any medical intervention. His weight and appetite were stable. His serologic profile for antibodies and gene mutations was all negative. In addition to that, the patient also had a past medical history of hypertension, hypercholesterolemia, gastroesophageal reflux disease (GERD), osteoporosis and bilateral inguinal hernia repair. In March 2014 the patient started experiencing painful ulcerations involving his penis, the inguinal region and the perianal area. Cultures from these lesions were negative, so were blood cultures. Basic labs including complete blood count, basic metabolic profile and liver function tests were all within normal limits. A trial of intralesional steroids by his dermatologist was unsuccessful. A biopsy from the lesions showed ulceration with granulation tissue and focal granulomatous inflammation. Immunohistochemistry for T. Pallidum and PAS were all negative for microorganisms. Review of his clinical picture and histology was felt to be consistent with Metastatic Crohn's Disease. RESULT(S): The patient was started on Infliximab infusions at a dose of 5 mg/kg. After the second infusion the ulcerations disappeared and only mild erythema remained. After the third infusion there was complete resolution of the lesions. The infusions are currently being continued once every 8 weeks. CONCLUSION(S): This case highlights a rare manifestation of Crohn's disease especially in the advanced elderly and emphasizes the utility of biologics as a treatment in this unique clinical scenario.