Managing metastatic Crohn’s disease: a single center experience, review of the current evidence, and treatment algorithm

Abstract

Background

Crohn’s disease (CD) is an inflammatory bowel disease (IBD) that, besides gastrointestinal symptoms, may encompass extra-intestinal symptoms, such as dermatological manifestations. Of those, metastatic CD (MCD) is a rare extra-intestinal manifestation for which the management is uncertain.

Methods

We conducted a retrospective case series of patients with MCD seen at the University hospital Leuven, Belgium, combined with an overview of the recent literature. Electronic medical records were searched from January 2003 till April 2022. For the literature search, Medline, Embase, Trip Database, and The Cochrane Library were searched from inception to April 1, 2022.

Results

A total of 11 patients with MCD were retrieved. In all cases noncaseating granulomatous inflammation was found on skin biopsies. Two adults and one child were diagnosed with MCD prior to their diagnosis of CD. Seven patients were treated with steroids (intralesional, topical or systemic). Six patients needed a biological therapy to treat MCD. Surgical excision was performed in three patients. All patients reported a successful outcome and most cases achieved remission. The literature search yielded 53 articles, including three reviews, three systematic reviews, 30 case reports and six case series. A treatment algorithm was generated based on literature and multidisciplinary discussion.

Conclusion

MCD remains a rare entity and diagnosis is often difficult. A multidisciplinary approach including skin biopsy is necessary to diagnose and treat MCD efficiently. Outcome is generally favorable, and lesions respond well to steroids and biologicals. We propose a treatment algorithm based on the available evidence and multidisciplinary discussion.

Keywords:

• Metastatic Crohn’s disease
• Crohn’s disease
• noncaseating granulomas
• extraintestinal manifestations
• IBD-clinical

Disclosure statement

Séverine Vermeire, MD, PhD has received grants from AbbVie, J&J, Pfizer, Takeda and Galapagos. Séverine Vermeire, MD, PhD has received consulting and/or speaking fees from: AbbVie, Abivax, AbolerIS Pharma, AgomAb, Alimentiv, Arena Pharmaceuticals, AstraZeneca, Avaxia, BMS, Boehringer Ingelheim, Celgene, CVasThera, Cytoki Pharma, Dr Falk Pharma, Ferring, Galapagos, Genentech-Roche, Gilead, GSK, Hospira, Imidomics, Janssen, J&J, Lilly, Materia Prima, MiroBio, Morphic, MrMHealth, Mundipharma, MSD, Pfizer, Prodigest, Progenity, Prometheus, Robarts Clinical Trials, Second Genome, Shire, Surrozen, Takeda, Theravance, Tillots Pharma AG, Zealand Pharma. João Guedelha Sabino, MD, PhD has received speaker’s fees from Pfizer, Abbvie, Ferring, Falk, Takeda, Janssen, and Fresenius. Joao Guedelha Sabino, MD, PhD has received consultancy fees from Janssen, Ferring, Fresenius, Abbvie, Galapagos, Celltrion, Pharmacosmos, and Pharmanovia and research support from Galapagos and Viatris. Tom Hillary, MD has received grants and consulting and/or speaking fees from: AbbVie, Almirall, Amgen, Biogen, Bristol Myers Squibb, Celgene, Janssen, Leo Pharma, Eli Lilly, Novartis, Pfizer Inc, Sandoz, Sanofi, UCB Pharma. The other authors declare having no conflict of interest in the realization of this research article.

Additional information

Funding

Judith Wellens was supported by the Research Foundation Flanders (FWO), Belgium by a PhD Fellowship strategic basic research (SB) grant [1S06023N]; Fonds Wetenschappelijk Onderzoek.