METASTATIC CROHN'S DISEASE INVOLVING PENILE SKIN

A 35-year-old man presented with nonhealing moist ulcers with granulation tissue on the subcoronal area of the penis 4 to 5 months in duration (fig. 1). In addition, he had noticed gradually worsening penile edema. He stated that he was sexually active with 1 female partner and denied a history of sexually transmitted disease or condom, lubricant and spermicide use. Medical history was significant for Crohn’s disease, which was currently quiescent and not under treatment. He had previously undergone proctectomy, and incision and drainage of recurrent buttock abscesses. Penile biopsy revealed squamous epithelium with parakeratosis and hyperplasia, as well as underlying chronic (lymphocyte and plasma cell) and granulomatous (epitheliod histiocyte and giant cell) inflammation consistent with Crohn’s disease (fig. 2). Tissue cultures for fungus and acid-fast bacilli were negative. ARer the biopsy a regimen of topical steroids was started. The patient returned 6 months later with marked improvement of the lesions.