Metastatic Crohn's disease. Case report and review of the literature.

Metastatic Crohn's disease is an unusual granulomatous inflammation of the skin that is noncontiguous to the gastrointestinal tract. Our review of the English-language literature shows that 23 cases of metastatic Crohn's disease have been published since its description in 1964. The skin lesions can be in the form of erythematous nodules, plaques, or ulcers, and the lower extremities are involved in half of the cases. We describe a 24-year-old woman with metastatic Crohn's disease. Ultrastructural examination revealed changes that were compatible with episodic endothelial cell injuries. Results of both direct and indirect immunofluorescence studies were negative. The possible role of T lymphocytes and macrophages in mediating this vascular damage is considered.