Case Report by Lehrnbecher

To The Editor: The recent case report of "metastatic" Crohn's disease by Lehrnbecher et al. ⁽¹⁾ is of interest but deserves some comment. First, although the dictionary definition of metastasis includes "transference of bodily disease from one part ... to another," ⁽²⁾ there is also a precise medicopathologic meaning that relates to the vascular or lymphatic spread of tumour cells. The use of the term "metastatic Crohn's disease," although prevalent in the literature, is therefore to be deprecated. "Noncontiguous cutaneous Crohn's disease" may be a preferable expression, because this distinguishes it from those cutaneous lesions that extend directly from the gastrointestinal tract and does not imply a pathologic mechanism.

Second, the authors state that to the best of their knowledge only one case had been reported in the pediatric literature, in a dermatology journal, although their report was received a month after the publication by Dutheil et al. ⁽³⁾ in the Journal of Pediatric Gastroenterology and Nutrition and followed at least two earlier cases published in the same journal ^(4,5). This phenomenon (also displayed in ^{reference 3}) is probably related to a desire not to draw attention to previous similar reports because of a "pathologic" fear of editorial rejection. I suggest this entity be termed "dyslexia obliterans" and that it be brought to the attention of all referees!

John Puntis

University Department of Pediatrics and Child Health; D Floor, Clarendon Wing; The General Infirmary at Leeds; United Kingdom