A 54 year-old male patient is followed in our department since 2007 for Crohn's disease (terminal ileitis).
He has been treated with Infliximab, 5mg/Kg for the last 4 years without any residual GI symptoms, his last colonoscopy is normal (June 2013).
Four months ago, he noticed a non-painful ulcerated lesion on his left leg whose diameter was increasing progressively (currently 3x3 cm).
Biopsies of this lesion found non-caseating granulomas and are consistent with metastatic Crohn's disease, a rare entity.
Dermatologic consultation was obtained and treatment with steroid injections on the site of the ulcerated lesion was started in addition to the Remicade (Infliximab).
No improvement was noticed till date.
What treatment do you suggest next:
-continue Infliximab and steroid injections
-add immunosuppressors
-change Infliximab to Adalimumab
-surgical treatment
-wait and see?
If no response to local steroids. Trough level infliximab before next infusion. If low consider dose attenuation and ad immunosuppressor. If not change to adalimumab.
If the lesion is single and medical therapy is ineffective, surgical removal may be considered. Another potential possibility coul be the use of stem cells. However, the problem of metastatic crohn's disease is that sporadica cases are reported in the literature and this makes impossible to address therapeutic guidelines.
Thank you for your answers. Here is the outcome of the case.
Surgical resection was finally decided and it proved to be a cutaneous squamous cell carcinoma. More details and discussion of the case is available on this link:
https://www.researchgate.net/post/Did_anybody_see_a_case_of_cutaneous_squamous_cell_carcinoma_under_Infliximab_treatment
Dr. Al Gossaini,
Thank you for the unusual case report.
...
So, and what about the granulomas found in the lesion? Mistake? And how did the ulcer look like? Have you got some pictures or microphotography?