ExtraINTESTINAL manifestations (EIMs) are common in patients with Crohn’, s DISEASE (CD). Various reactive cutaneous conditions, including erythema nodosum and pyoderma gangrenosum frequently occur as a part of EIMs. However, cutaneous metastasis of CD is rarely encountered in CD patients. Here, we report a 28‑, year‑, old female patient presenting with discharging deep fissures on genital and intergluteal regions. The result of a skin biopsy showed noncaseating granulomas. After rule out all the other differential diagnoses for granulomatous skin lesions, we believe this patient may be a case of CD, presenting with skin metastasis and GI tract involvement has not been occurred during 1‑, year follow‑, up. We suggest including cutaneous (metastatic) CD in the list of dermatologic differential diagnoses for cutaneous lesions of these sites. These lesions can occasionally precede gastroINTESTINAL (GI) involvement by months and years, therefore, an appropriate follow‑, up needs to be done to detect GI lesions as soon as they appear.

Background: Celiac is a common multisystem autoimmune DISEASE with prevalence of about 1%. For every recognized case of celiac DISEASE, 8 more remain undiagnosed. Asymptomatic or minimally symptomatic celiac DISEASE is probably the most common form of the DISEASE, especially in older children and adults. Celiac DISEASE is no longer a disorder limited to childhood and adolescence; it has even been diagnosed for the first time in elderly patients. Infants and young children typically present with chronic diarrhea, anorexia, abdominal distension, abdominal pain, poor weight gain or weight loss, and vomiting. Severe malnutrition can occur if the diagnosis is delayed. Behavioral changes are common and include irritability and an introverted attitude. Rarely, severely affected infants present with a celiac crisis, which is characterized by explosive watery diarrhea, marked abdominal distension, dehydration, hypotension, and lethargy, often with profound electrolyte abnormalities, including severe hypokalemia. Older children with celiac DISEASE who present with GI manifestations may have onset of symptoms at any age. GI symptoms in older children are typically less evident and include nausea, recurrent abdominal pain, bloating, constipation and intermittent diarrhea. Because of the myriad and frequently enigmatic presentations of celiac DISEASE, the challenge of diagnosis falls squarely on the shoulders of primary care practitioners. In infants and toddlers, GI symptoms and FTT predominate, whereas, during childhood, minor GI symptoms, inadequate rate of weight and height gain, and delayed puberty tend to be more common. In teenagers and young adults, anemia is the most common form of presentation. In adults and in the elderly, GI symptoms are more prevalent, although they are often minor. The main extraINTESTINAL manifestations of celiac DISEASE are as follows: dermatitis herpetiformis, dental enamel hypoplasia, aphthous ulcers, delayed tooth eruption, Iron-deficiency anemia, short stature and delayed puberty, chronic hepatitis and hypertransaminasemia, arthritis and arthralgia, osteopenia and osteoporosis, neurological problems, psychiatric disorders (autism, attention deficit hyperactivity disorder), subfertility or infertility. Celiac DISEASE is also known to be strongly associated with numerous disorders, specifically with autoimmune conditions and genetic syndromes.

Introduction. This fascinating disorder is also known as Sinus Histiocytosis. It is very rare, probably less than 1000 cases reported in the literature. R.D.D affects lymph nodes, although extranodal involvement has been reported such as: Centaral nervous system (CN.S). All of the cases of R.D.D with CN.S involvement without other sites involvement are 11 cases. Methods. The case is a male patient, 26y/o, with a history of head trauma 2 years ago that has been resulted to unconsciousness. He has been referred to a hospital and brain CT scan and brain M.R.I has been done for him. In M.R.I a brain tumor with left orbit and sphenoidal sinus involvement and compression effect on frontal lobe has been seen. A neurosurgeon operated him and the pathological report was Rosai-Dorfman DISEASE. Then he was referred to radiation therapy department.Results. Treatment approach in CN.S involvement cases consists of surgery, radiotherapy and chemotherapy. Discussion. Over all, response has been inferior to those expected with malignant hematopoietic neoplasms.

Dear Editor, Thank you for providing us an opportunity to report a case of rare atypical Kawasaki DISEASE (KD). As we know, KD is an acute febrile illness of childhood associated with vasculitis of medium-sized arteries, especially the coronary arteries.Through this letter, we would like to share our experience managing the case of a 7-month-old boy suffering from a rare atypical KD, which presented as INTESTINAL pseudo-obstruction without fever. …

Background and Aim: Crohn's DISEASE is a chronic idiopathic DISEASE in the category of gastroINTESTINAL tract inflammation without any obvious reason. Clinical signs include abdominal pain, and diarrhea, which may be accompanied by a fistula or INTESTINAL obstruction. Differential diagnosis of Crohn’ s DISEASE and INTESTINAL tuberculosis is a complex and difficult challenge. Case presentation: The patient was a 70-year-old woman who had been hospitalized due to fistulas with 4 years of discharge in the left inguinal and gluteal area. The patient's vital signs were stable, and she did not report any fever, chills, or gastroINTESTINAL symptoms. Diagnostic tuberculosis procedures were performed for this patient and despite the lack of evidence in favor of INTESTINAL tuberculosis, experimental tuberculosis treatment was started for him. Despite 10 months of anti-tuberculosis treatment, the symptoms and fistulas of the patient did not recover in 2016. On spiral computed tomography scan of the lung and mediastinum without injection, the presence of cardiomegaly, evidence of ground-glass was seen along with an increased thickness of the interlobular septa in the middle lobe of the right lung and ground glass opacities at the base of both lungs. Since the patient had typical INTESTINAL tuberculosis symptoms, discharge cultivation and smear were performed and it did not grow on Mycobacterium tuberculosis bacillus acid staining. The patient underwent biopsy with MR Enterography, and Crohn’ s diagnosis was confirmed. The patient was treated with Metronidazole, Ciprofloxacin, and a combination of Azathioprine and Infliximab. Conclusion: According to the rare case reported, advanced diagnostic measures should be taken in dealing with patients with INTESTINAL tuberculosis or Crohn’ s DISEASE.