Cutaneous Crohn’s Disease as the First Presentation: A Natal Cleft Lesion in a Middle-Aged Woman

Background: Cutaneous Crohn’s disease, particularly as an initial presentation without gastrointestinal involvement, is exceedingly rare. Natal cleft lesions can mimic other inflammatory or infectious conditions, delaying diagnosis. Case Presentation: A 43-year-old woman presented with a perianal fistula and a friable natal cleft lesion. Endoscopic and radiologic investigations were unremarkable. Histopathology of the lesion revealed non-caseating granulomas and plasma cell infiltration, consistent with cutaneous Crohn’s disease. Infectious causes were excluded. The patient responded well to metronidazole and anti-TNF therapy. Conclusion: This case underscores the need for heightened clinical suspicion of metastatic Crohn’s disease in atypical cutaneous presentations, especially in the natal cleft region.