Successful treatment of therapy-resistant metastatic Crohn's disease with infliximab

Sir, Metastatic Crohn's disease is a rare dermatological manifestation of Crohn's disease in which there is prominent granulomatous inflammation involving a skin area that can be distant from the affected gastrointestinal tract.1 The cutaneous lesions (papules that may enlarge, ulcerate and/or drain pus) can occur at various locations, although they are most frequent in the perineal region, particularly in patients with fistulizing perianal disease or previous proctectomy.2 In contrast to other cutaneous manifestations of Crohn's disease, such as erythema nodosum or pyoderma gangrenosum, metastatic Crohn's disease usually has an unsatisfactory response to medical and/or surgical therapy. A complete healing of the lesions is rarely obtained by medical treatment, although some partial benefit has been reported following treatment with azathioprine,3 steroids,4 mycophenolate mofetil,5 surgery and hyperbaric oxygen therapy.6 Infliximab, an antitumour necrosis factor (TNF)‐α chimeric monoclonal antibody, has been used successfully in fistulizing perianal Crohn's disease,7 and its potential efficacy in the treatment of cutaneous metastatic complications of Crohn's disease has recently been suggested.2, 8, 9 We report a patient with metastatic Crohn's disease that was treated successfully with infliximab.