[Cheilitis granulomatosa revealing Crohn's disease]

Many disorders of the digestive tract cause cutaneous manifestations that may be an indication of an underlying condition; hence dermatologist plays a key role in recommending that the patient see a gastroenterologist. Conversely, gastroenterologist often sees patients with mucocutaneous lesions suggesting possible association with well-known digestive disorders. Chronic inflammatory bowel diseases are the typical example of this essential collaboration between the two specialities. We report a case of Crohn's disease revealed by cheilitis granulomatosa. This study involved a 30-year old female patient followed up for cheilitis granulomatosa in the Department of Dermatology. Somatic examination was unremarkable apart from dermatologic lesions (indurated white faciolabial edema and diffuse gingivitis). Biopsy of the labial lesion revealed perivascular epithelioid and giant-cell granulomas without caseous necrosis. Ileocolonoscopy was performed due to suspected inflammatory colitis. It showed gaping and ulcerated Bauhin valve with slightly erythematous ileal mucosa. Anatomo-pathologic study objectified chronic inflammatory bowel disease (CIBD) such as ileocolic Crohn's disease. Patient's evolution was marked by some episodes of rectal bleeding with anoperineal lesions 6 months later: a wide anterior anal fissure with aphthous ulceration 5 cm from the anal margin, complicated, a few weeks later, by the onset of perianal fistulized abscess requiring surgical drainage and seton installation. Hence the indication for thorough treatment of Crohn's disease after complete drying up of the abscess. Dermatologic lesions vary in patients with CIBD. In some cases, they occur in patients with IBD whereas, in other cases, they precede or accompany digestive manifestations, allowing diagnosis of sometimes clinically latent bowel disease.