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+A 26 year old patient was referred from the outpatient department of the digestive service to assess some lesions that had recently appeared on the preputial skin.
+His family history includes Crohn's disease in a twin brother; his personal history includes Crohn's disease diagnosed six years earlier, which has presented with severe outbreaks during these years and has required treatment with corticoids and immunosuppressants.
+In one of these flare-ups, surgery was necessary, in which a total colectomy and ileostomy were performed according to the Brooke technique. The immediate postoperative course was satisfactory.
+In the months following the operation, he developed severe granulomatous rectitis, treated with deflazacort and mesalazine rectal enemas.
+The patient is also being studied by the haematology department for persistently prolonged activated partial thromboplastin time (APTT).
+He was referred to us from the Digestive outpatient clinic for presenting a lesion on the preputial skin that had been present for a year and a half, in the form of an erythematous, ulcerated plaque. It had been treated with topical corticosteroids with the diagnosis of suspected pyoderma gangrenosum, but had not progressed satisfactorily. In addition, the patient reported itching and some suppuration, so a sample was taken for culture, which showed growth of urethral colonising flora with no pathological significance.
+It was decided to perform a circumcision, sending the preputial skin to the pathological anatomy service with the following result: non-caseating granuloma, with ulceration, typical of metastatic Crohn's disease.
+
+After excision of the lesion, no recurrence was observed after one year of follow-up.
+
+