RESOLUTION OF METASTATIC CROHN’S DISEASE AFTER TREATMENT WITH CERTOLIZUMAB V Bolgiano, DO, D Cohen MD, S Walker MD Department of Medicine, Louisiana State University Health Sciences Center, Lafayette, LA INTRODUCTION Crohn’s disease (CD) is a chronic inflammatory bowel disease (IBD) which may have distinctive mucocutaneous manifestations. Up to 33% of IBD patients have at least one extraintestinal disease manifestation. To our knowledge, this is the first case to describe success in treating MCD with certolizumab alone. CASE: A 63-year-old woman with a previous history of Crohn’s disease presented to the dermatology clinic for evaluation of a rash located on her right upper lip. She reported that the rash appeared two years prior. It was associated with pruritus and moderate swelling. Histopathological findings from a 4.0 mm punch biopsy revealed multiple nodular granulomatous infiltrates extending from the superficial reticular to deep reticular dermis. The granulomas were composed of numerous histiocytes as well as a moderately dense inflammatory infiltrate made up predominantly of lymphocytes with scattered plasma cells and eosinophils. S-100 staining was negative. PAS and Fite stains were negative for infectious organisms. The patient had tried Humira, Imuran, Remicade, Plaquenil, Minocycline, and intralesional Kenalogwithminimal improvements. This patient ultimately responded to the induction dose of 400mg certolizumab (2 injections of 200mg) andwas prescribed a maintenance dose of 400 mg every other week that will require long-term follow up. DISCUSSION: Metastatic Crohn’s disease is a rare, non-contiguous cutaneous manifestation of primary CD, being the least common presentation of extra-intestinal CD. Most cases of MCD occur on the lower extremities, intertriginous areas, face, and genital area. No clear correlation between the development of MCD and luminal disease activity has been established. Adalimumab, infliximab, antibiotics, systemic & topical corticosteroids, methotrexate, and azathioprine have demonstrated benefit in MCD. Certolizumab (certolizumab pegol) is a PEGylated anti-tumor necrosis factor biologic therapy approved for use in Crohn’s disease among other diseases.
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