Granulomatous Cheilitis as the Presenting Manifestation of Widespread Crohn's Disease

Granulomatous cheilitis, a localized subset of orofacial granulomatosis, can rarely be the presenting symptom of Crohn's disease. It can appear before any gastrointestinal (GI) symptoms develop. Orofacial granulomatosis has been associated with more widespread granulomatous Crohn's disease, which tends to be more aggressive. We present a case of isolated granulomatous cheilitis progressing to diffuse granulomatous involvement of multiple portions of the upper and lower GI tract with eventual secondary loss of response to initial anti-tumor necrosis factor-α therapy, underscoring the need for these patients to be monitored very closely even in the absence of GI symptoms.