Dermatofibroma in a patient with Crohn's disease: a novel clinical manifestation.

Crohn's disease (CD) is an inflammatory disease of the digestive tract, which could affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It is often associated with extraintestinal manifestations, complications, and other autoimmune disorders. Although dermatofibromas (DF) are benign dermal nodules mostly affecting the extremities, shoulders, and buttocks of young adults it has not been reported among the skin manifestations of CD. Reported herein is the first case of a newly diagnosed CD with dermatofibroma. A 19-year-old female had been in good health until 15 days before hospital admission when she complained of fatigue, abdominal pain, and rectal bleeding of bright red blood. Physical examination revealed pallor, tachycardia and hypotension (blood pressure 90/45 mmHg), and mild abdominal tenderness. Her laboratory analyses were within normal ranges except for: hemoglobin, 8.9 g/dl (14–18); hematocrit, 26.2% (40–55); erythrocyte sedimentation rate, 41 mm/h (0–15); high sensitivity C-reactive protein (HsCRP), 7.6 mg/l (0–0.74). Stool culture and Clostridium difficile cytotoxin assay were negative. Colonoscopy (performed with Olympus CF-1T20L) revealed highly inflamed mucosa with aphthous lesions, deep indurative ulcerations and pseudopolyps involving the 40 cm from the anal verge. Approximately 60 cm from the anal verge, villous projections were seen, obscuring the lumen of the colon. The mucosa between 40 and 60cm appeared normal. Histologic studies from rectal biopsies revealed chronic active colitis. During examinations, the patient developed hyperemic and eruptive skin lesions on right lumbar region (Fig. 1a) and on her thigh. Biopsy from these lesions revealed a moderately cellular fibrous tumor located in the dermis, consistent with dermatofibroma (Fig. 1b). With these findings sulfasalazine and prednisolone therapy was initiated. The patient responded favorably to combination therapy, her skin lesions were also regressed after treatment. CD and ulcerative colitis, the 2 main subtypes of inflammatory bowel disease (IBD), are autoimmune disorders of unknown etiology that characterized by ulcerative lesions of the bowel. Multiple other organ systems can be affected, including the skin, bones and joints, eyes, hepatobiliary