When the Spleen Speaks First: Aseptic Abscess as the Herald of Crohn's Disease

Abstract Background: Crohn’s disease is a chronic inflammatory bowel disease (IBD) that may present with a range of extraintestinal manifestations, including cutaneous, hematologic, and hepatosplenic involvement. Aseptic splenic abscesses and pyoderma gangrenosum are rare initial presentations. Case presentation: We present the case of a 31-year-old woman with chronic abdominal pain, fever, joint swelling, skin ulcerations, and melena. Extensive workup revealed aseptic splenic abscesses, colonic inflammation consistent with Crohn’s disease, and pyoderma gangrenosum. Infectious and malignant causes were ruled out. She responded to corticosteroids and immunosuppressive therapy with Azathioprine. Conclusions: This case highlights the need for high clinical suspicion for Crohn’s disease in patients with unexplained systemic inflammation and splenic lesions. Aseptic splenic abscesses and pyoderma gangrenosum may be rare but significant extraintestinal features that warrant early recognition and immunosuppressive therapy.