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Related Experiment Videos

Perianal Crohn's disease.

M S Morales1, M Marini, M Caminero

  • 1Department of Dermatology, Ramos Mejía and British Hospitals, Buenos Aires, Argentina.

International Journal of Dermatology
|September 6, 2000
PubMed
Summary

A pediatric case presents with perianal skin tags and gastrointestinal symptoms, diagnosed as granulomatous disease. Treatment with anti-inflammatory and antimicrobial agents showed moderate effectiveness.

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Area of Science:

  • Gastroenterology
  • Dermatology
  • Pediatrics

Background:

  • This case report details a 13-year-old girl presenting with a 4-month history of perianal skin lesions.
  • The patient exhibited systemic symptoms including intermittent fever, diarrhea, abdominal pain, and failure to thrive, with body weight below the third percentile.

Observation:

  • Physical examination revealed three fleshy, red, swollen skin tags in the perianal area.
  • Laboratory findings indicated significant inflammation (ESR 101 mm/h), anemia (hematocrit 26%), and iron deficiency (transferrin saturation 6%), alongside hypoalbuminemia.
  • Imaging studies showed colonic irregularities, with colonoscopy revealing mucosal edema, pseudopolyps, thickening, and stenosis.

Findings:

  • Histopathological examination of both skin and large intestine lesions confirmed noncaseating epithelioid and giant cell granulomas.
  • Infectious etiologies, including acid-fast bacilli and fungi, were ruled out. Toxoplasma titers were elevated.
  • The patient's condition was diagnosed as a form of granulomatous disease affecting both the skin and the gastrointestinal tract.

Implications:

  • This case highlights the importance of considering granulomatous disease in pediatric patients with unexplained perianal lesions and gastrointestinal symptoms.
  • The findings underscore the need for a multidisciplinary approach involving gastroenterology, dermatology, and pathology for accurate diagnosis and management.
  • Treatment with metronidazole, prednisone, and acetylsalicylic acid, along with nutritional support, provided moderate clinical improvement, suggesting a potential therapeutic strategy for similar cases.

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