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Crohn's disease initiated with extraintestinal features
Jeffrey Chang1,2, Chia-Cheng Li3, Marina Achtari4
1Department of Gastroenterology, Nutrition and Hepatology, Boston Childrens Hospital, Boston, Massachusetts, USA.
BMJ Case Reports
|April 22, 2019
Summary
Oral manifestations like lip swelling can indicate Crohn's disease (CD) in children. Early diagnosis through these signs aids in timely management of this chronic immune disorder.
Area of Science:
- Gastroenterology
- Immunology
- Pediatrics
Background:
- Crohn's disease (CD) is a chronic immune-mediated disorder with potential oral manifestations.
- Oral involvement in CD ranges from 0.5% to 20% of patients and can precede intestinal symptoms.
Observation:
- A pediatric case presented with persistent idiopathic lower lip swelling and a perianal fistula.
- Microscopic examination revealed non-necrotizing granulomas, chronic inflammation, edema, and lymphangiectasia.
Findings:
- The patient received a combination of metronidazole and ciprofloxacin for infection.
- Perioral lesions were treated with topical tacrolimus and oral prednisone, showing improvement but not full remission.
Implications:
- Oral manifestations can be crucial indicators for early Crohn's disease diagnosis in pediatric patients.
- This case highlights the importance of recognizing nonspecific oral signs for timely intervention in CD management.