Track

Abstract

A 48-year-old immunocompromised man with long-standing Crohn’s disease on infliximab, status post proctectomy and partial colectomy with ostomy, presented with an 18-month history of progressive swelling and erythema involving the groin, penis, and scrotum, complicated by episodes of acute testicular pain and fever. Despite ongoing treatment for superimposed cellulitis and suspected lymphedema, the diagnostic picture remained challenging. A biopsy of an erythematous plaque on the left scrotum revealed chronic spongiotic dermatitis with dermal lymphedema and scattered rare multinucleated giant cells localized within lymphatic vessels. Multiple deeper sections failed to identify well-formed granulomas. Special stains for fungi and mucin (PAS-D, Alcian blue/PAS) were negative. The presence of intralymphatic multinucleated giant cells, although nonspecific, aligns with reported histopathologic features of genital cutaneous or metastatic Crohn’s disease. These findings likely reflect granulomatous lymphatic involvement resulting in lymphatic obstruction and secondary lymphedema. This case underscores the diagnostic challenge of Crohn’s disease presenting with cutaneous manifestations mimicking infectious folliculitis or cellulitis, especially in immunosuppressed patients. Recognition of subtle clues such as intralymphatic giant cells within a compatible clinical context is critical to distinguishing this entity from infectious or neoplastic mimics. This report contributes to the dermatopathology literature by highlighting a rare but important histologic correlate of genital Crohn’s disease and emphasizing the role of thorough clinicopathologic correlation in managing complex inflammatory skin lesions.