title: Metastatic Crohn's disease in pediatrics.
abstract: OBJECTIVE
  Metastatic Crohn's disease (MCD) is an extraintestinal manifestation of Crohn's disease, with biopsy as fundamental diagnostic tool. There are few references to MCD in children, with a 0.5-1% estimated incidence in adults. There is no consensus about its therapeutic approach. We describe our diagnostic and therapeutic experience in MCD.
  
  
  RESULTS
  Four cases of MCD are described in our Pediatric Gastroenterology Unit in a tertiary care hospital. The age at diagnosis was between 7 and 13 years. Lesions appeared before the diagnosis of Crohn's disease in three of them, and during the course of the disease in another one, with genital location in three patients and bilateral pretibial region in the other. All four cases demonstrated non-caseificant granulomas on biopsy. Only two patients used exclusive enteral nutrition therapy with complete resolution, while other two cases received a combination of therapies (corticosteroids, azathioprine, tacrolimus, infliximab and adalimumab) because of recurrence. Only one case required surgery after poor clinical control.
  
  
  CONCLUSIONS
  The MCD is infrequent but must always be included in the differential diagnosis of cutaneous lesions in Crohn's disease, considering it could be the debut of the disease. We will rely on biopsy anyway for definitive diagnosis. In this series the genital region is verified as the most commonly affected in children. The therapeutic approach does not differ from the management of intestinal involvement.
authors: Gastroenterología, Hepatología y Nutrición Infanti, Hospital Regional Universitario de Málaga, España.
authors: Javier
authors: J
authors: Blasco Alonso
authors: Gastroenterología Infantil, Hospital Universitario San Cecilio de Granada, España.
authors: Francisco
authors: F
authors: Girón Fernández-Crehuet
authors: UGC Pediatría, Hospital Regional Universitario de Málaga, España.
authors: Miguel A
authors: MA
authors: Lendínez Ramírez
authors: UGC Pediatría, Hospital Regional Universitario de , España.
authors: Sivia
authors: S
authors: Gallego Gutiérrez
authors: UGC Pediatría, Hospital Regional Universitario de , España.
authors: Silvia
authors: S
authors: Luque Pérez
authors: UGC Pediatría, Hospital Regional Universitario de Málaga, España.
authors: Juliana
authors: J
authors: Serrano Nieto
authors: Gastroenterología,Hepatología y Nutrición Infantil, Hospital Regional Universitario de Málaga, España.
authors: Víctor M
authors: VM
authors: Navas López
authors: UGC Pediatría, Hospital Regional Universitario de Málaga, España.
authors: Carlos
authors: C
authors: Sierra Salinas
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D003424:Crohn Disease / Q000209:etiology / Q000473:pathology*; D005260:Female; D005835:Genitalia / Q000473:pathology; D006801:Humans; D008297:Male; D012867:Skin / Q000473:pathology