1
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Kim S, Won YB, Seo SK, Cho S, Choi YS, Lee BS, Yun BH. Vulvar Crohn's disease in an adolescent diagnosed after unsuccessful surgical treatment. BMC Womens Health 2021; 21:316. [PMID: 34454474 PMCID: PMC8399794 DOI: 10.1186/s12905-021-01449-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/10/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND This case report presents a case of Vulvar Crohn's disease (VCD) in an adolescent, that is an uncommon manifestation of Crohn's disease (CD) without gastrointestinal symptoms. Before treating CD itself with proper medication, vulvar abscess continued to recur without improvement. CASE PRESENTATION We report the case of an 18-year-old woman with VCD. After treatment with azathioprine 50 mg daily and mesalazine 1 g three times daily, vulvar lesions resolved after 6 weeks. We collected electronic medical data on patient characteristics, and evaluated findings of physical examinations, pelvic MRI, and biopsy specimen obtained from gastroduodenoscopy/colonoscopy. CONCLUSIONS VCD is a rare manifestation of CD that may be misdiagnosed in the absence of gastrointestinal symptoms leading to delayed treatment. If a patient has an unexplained vulvar inflammatory lesion and with repeated failed surgical treatment, gynecologists should consider the possibility of a VCD.
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Affiliation(s)
- Suhra Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Bin Won
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - SiHyun Cho
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Sik Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Seok Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, Korea.
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2
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Goyal P, Nijhawan S, Nijhawan M, Agrawal S. Refractory cutaneous Crohn's disease of the external genitalia in a female. Indian J Sex Transm Dis AIDS 2020; 41:110-113. [PMID: 33062996 PMCID: PMC7529167 DOI: 10.4103/ijstd.ijstd_32_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/17/2017] [Accepted: 12/30/2019] [Indexed: 12/01/2022] Open
Abstract
Cutaneous lesions as a part of Crohn's disease (CD) may occur as a totally separate entity without the involvement of the gastrointestinal tract, in which case it is termed as metastatic CD. A 23-year-old female presented with complaints of vulvar swelling and multiple, oval-linear, typical knife cutting deep ulcers on the perineal folds. Biopsy showed epithelioid cell granuloma in the dermis. Differential diagnosis included cutaneous tuberculosis, sarcoidosis, deep fungal infection, and CD of the vulva. A diagnosis of CD was made by the exclusion. The patient was earlier treated with oral steroids, antibiotics, antituberculosis treatment, and azathioprine but showed only mild improvement. Therefore, the condition was regarded as a refractory one. The patient showed significant improvement after six cycles of adalimumab.
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Affiliation(s)
- Pallavi Goyal
- Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Shivi Nijhawan
- Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Manisha Nijhawan
- Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Savita Agrawal
- Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
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3
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Desquamative Inflammatory Vaginitis as an Extraintestinal Manifestation of Crohn’s Disease. Curr Infect Dis Rep 2020. [DOI: 10.1007/s11908-020-00733-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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4
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Bondarenko KR, Dobrokhotova YE, Rumyantseva TA, Nasyrova NI. Crohn's disease of the vulva: A tough diagnosis (a case report of a 47 y.o. patient). Clin Case Rep 2020; 8:563-567. [PMID: 32185060 PMCID: PMC7069867 DOI: 10.1002/ccr3.2707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/22/2019] [Accepted: 01/07/2020] [Indexed: 11/16/2022] Open
Abstract
Extraintestinal symptoms of Crohn's disease may occur in the eye, the urinary system, on the skin, or subcutaneous fat. We report the case of a 7-year diagnostic search of isolated vulvar Crohn's disease in a 47-year-old woman. The disease is characterized by gradual formation of pronounced bilateral asymmetric labial hypertrophy.
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Affiliation(s)
- Karina R. Bondarenko
- Department of Obstetrics and GynecologyTherapeutic FacultyPirogov Russian National Research Medical UniversityMoscowRussia
| | - Yulia E. Dobrokhotova
- Department of Obstetrics and GynecologyTherapeutic FacultyPirogov Russian National Research Medical UniversityMoscowRussia
| | | | - Nailya I. Nasyrova
- Department of Obstetrics and GynecologyTherapeutic FacultyPirogov Russian National Research Medical UniversityMoscowRussia
- Department of GynecologyCentral Clinical Hospital of Civil AviationMoscowRussia
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5
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Schneider SL, Foster K, Patel D, Shwayder T. Cutaneous manifestations of metastatic Crohn's disease. Pediatr Dermatol 2018; 35:566-574. [PMID: 29952016 DOI: 10.1111/pde.13565] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Metastatic Crohn's disease is a rare cutaneous complication of primary Crohn's disease. It is a granulomatous inflammatory process, similar to the pathogenic mechanism of Crohn's disease, that occurs in sites discontiguous from the gastrointestinal tract. Metastatic Crohn's disease can precede the development of Crohn's disease by months to years, and children are more likely to present with metastatic Crohn's disease in the absence of gastrointestinal symptoms. Given that approximately 30% of individuals with Crohn's disease present in childhood, early recognition of extraintestinal manifestations of Crohn's disease such as metastatic Crohn's disease can aid in timely diagnosis and management of bowel disease. We present data from two pediatric cases of metastatic Crohn's disease recently seen at our institution in addition to the 61 reported cases of pediatric metastatic Crohn's disease in the literature. This review article will focus on the epidemiology, pathogenesis, clinical features, and histology of and treatment options for pediatric metastatic Crohn's disease.
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Affiliation(s)
| | | | - Devika Patel
- Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - Tor Shwayder
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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6
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Alexakis C, Gordon K, Mellor R, Chong H, Mortimer P, Pollok R. Ano-genital Granulomatosis and Crohn's Disease: A Case Series of Males Presenting with Genital Lymphoedema. J Crohns Colitis 2017; 11:454-459. [PMID: 27683802 DOI: 10.1093/ecco-jcc/jjw173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 09/27/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Ano-genital granulomatosis is a rare chronic granulomatous condition of the skin that causes lymphoedema of the external genitalia. There is a reported association with Crohn's disease. Mechanisms of disease and optimal methods of treatment are poorly understood. METHODS A retrospective casenote review of 25 male patients with ano-genital granulomatosis presenting with genital lymphoedema was performed to determine the clinical and histopathological features of this condition and its relationship to intestinal Crohn's disease. RESULTS A combination of penile and scrotal oedema was reported at presentation in 80% of patients; 40% of patients had associated intestinal Crohn's disease. The average time from symptom onset to diagnosis was 52.7 months. Half of cutaneous biopsies contained non-caseating granulomas and 14% contained intralymphatic granulomas. In all, 72% of patients responded to oral steroids initially but recurrence was common. Complete or partial response was achieved in 60% of patients treated with azathioprine. Three of six patients responded to anti-tumour necrosis factor [TNF] therapy. A small proportion of patients required circumcision or de-bulking surgery for more debilitating disease. CONCLUSIONS Ano-genital granulomatosis is a rare condition that presents with genital lymphoedema, and there is frequently a protracted delay in diagnosis. There is a very strong association with intestinal Crohn's disease. Genital lymphoedema associated with gastrointestinal symptoms should prompt careful evaluation to exclude both ano-genital granulomatosis and Crohn's disease.
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Affiliation(s)
| | - Kristiana Gordon
- Department of Dermatology and Lymphoedema, St George's University Hospital, London, UK
| | - Russell Mellor
- Department of Dermatology and Lymphoedema, St George's University Hospital, London, UK
| | - Heung Chong
- Department of Cellular Pathology, St George's University Hospital, London, UK
| | - Peter Mortimer
- Department of Dermatology and Lymphoedema, St George's University Hospital, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospital, London, UK
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7
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Das D, Gupta B, Saha M. Metastatic Vulvar Crohn's Disease-A Rare Case Report and Short Review of Literature. Indian J Dermatol 2016; 61:70-4. [PMID: 26955098 PMCID: PMC4763698 DOI: 10.4103/0019-5154.174028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Metastatic Crohn's disease (CD), a type of extraintestinal CD may present with gynecological manifestation which causes diagnostic dilemma and needs multidisciplinary approach. Vulvar lesions occur in very small number of cases with CD of which asymmetrical labial swelling and edema is the most common presentation. We report a case of hypertrophic exophytic variety of vulvar CD because of its rarity.
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Affiliation(s)
- Debajit Das
- From the Department of Dermatology, Silchar Medical College, Silchar, Assam, India
| | - Bhaskar Gupta
- From the Department of Dermatology, Silchar Medical College, Silchar, Assam, India
| | - Mahimanjan Saha
- From the Department of Dermatology, Silchar Medical College, Silchar, Assam, India
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8
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Abstract
Crohn's disease (CD) of the vulva is a rare, yet under recognized condition. Fistulae arising from the digestive tract account for the greater part of genital lesions in CD. However, cutaneous so-called metastatic lesions of the vulva have been reported in the literature. They are clinically challenging for gastroenterologists as well as for gynecologists, with numerous differential diagnoses, especially among venereal diseases, and require a multidisciplinary approach. The most frequently observed features of the disease are labial swelling, vulvar ulcers, and hypertrophic lesions. Biopsy samples for histological study are mandatory, in order to establish the diagnosis of vulvar CD. Treatment options include oral prolonged courses of metronidazole and systemic immunosuppressive therapy such as corticosteroids and azathioprine, with promising data published on the efficacy of infliximab. Surgery remains restricted to medical treatment failures or resection of unsightly lesions. Prospective studies or case series with long follow-up data are still missing to guide the treatment of this condition.
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9
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Abstract
Crohn's disease, first described in 1922, is characterized by segmental granulomatous inflammation of the intestinal tract and frequently involves the cutaneous tissues as well. Cutaneous Crohn's disease (CCD) is synonymous with metastatic Crohn's disease (MSD). A case of CCD, without any gastrointestinal involvement is reported for its rarity.
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Affiliation(s)
- Padmavathy Lanka
- Division of Community Medicine, Urban Health Centre, Tamil Nadu, India
| | - Lakshmana Rao Lanka
- Division of Pathology, Rajah Muthiah Medical College, Annamalai University, Tamil Nadu, India
| | - N Sylvester
- Division of Pathology, Rajah Muthiah Medical College, Annamalai University, Tamil Nadu, India
| | - M Dhana Lakshmi
- Division of Pathology, Rajah Muthiah Medical College, Annamalai University, Tamil Nadu, India
| | - N Ethirajan
- Division of Community Medicine, Rajah Muthiah Medical College, Annamalai University, Tamil Nadu, India
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10
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Papalas JA, Robboy SJ, Burchette JL, Foo WC, Selim MA. Acquired vulvar lymphangioma circumscriptum: a comparison of 12 cases with Crohn's associated lesions or radiation therapy induced tumors. J Cutan Pathol 2010; 37:958-65. [PMID: 20653826 DOI: 10.1111/j.1600-0560.2010.01569.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lymphangioma circumscriptum (LC) is a benign lesion of lymphatic origin. Vulvar involvement occurs in various clinical settings. METHODS We present 12 cases, and compare lesions in patients with Crohn's disease and those associated with pelvic radiation. RESULTS The average age at presentation was 49 years. Thirty-three percent of the patients had Crohn's disease, 58% had radiation therapy and 9% had no significant medical history. Sixty-seven percent of the patients had multifocal lesions in anatomically distinct regions. Patients presented on average 16 years after onset of predisposing factors. Presenting complaints were pruritus, wetness and vulvar edema. Lesions were clinically heterogeneous, often found on the labia majora. Lesions consisted of dilated lymphatic channels at the junction of the reticular and papillary dermis. The cells lining these spaces lacked cytologic atypicality or mitotic activity. All lesions so examined were immunoreactive for D240. Patients were most often treated with surgical excision followed by laser ablation. Four of twelve patients, all with radiation-associated lesions, experienced disease progression necessitating additional surgery. CONCLUSIONS Patients with LC secondary to radiation, when compared to those with Crohn's disease, were 10 years younger, more likely to have associated co-morbidities, and frequently experienced disease progression needing additional surgeries. Acquired vulvar LC has multiple causes with differing prognosis.
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Affiliation(s)
- John A Papalas
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
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11
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MUN JH, KIM SH, JUNG DS, KO HC, KIM MB, KWON KS. Unilateral, non-tender, vulvar swelling as the presenting sign of Crohn’s disease: A case report and our suggestion for early diagnosis. J Dermatol 2010; 38:303-7. [DOI: 10.1111/j.1346-8138.2010.00991.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Corbett SL, Walsh CM, Spitzer RF, Ngan BY, Kives S, Zachos M. Vulvar inflammation as the only clinical manifestation of Crohn disease in an 8-year-old girl. Pediatrics 2010; 125:e1518-22. [PMID: 20457677 DOI: 10.1542/peds.2009-1829] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Recognition of Crohn disease in children who present with cutaneous vulvar lesions as their initial clinical manifestation is often difficult. We report here the case of an 8-year-old girl with chronic vulvar edema, which on biopsy revealed granulomatous inflammation of the vulva. Further investigation and biopsy of the terminal ileum demonstrated similar findings and was consistent with a diagnosis of Crohn disease.
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Affiliation(s)
- Shannon L Corbett
- Department of Pediatrics, Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8
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13
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Phillips SS, Baird DB, Joshi VV, Rosenberg AJ, Janosk O EO. Crohn's Disease of the Prepuce in a 12-Year-Old Boy: A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15513819709168590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Andreani S, Ratnasingham K, Dang H, Gravante G, Giordano P. Crohn's disease of the vulva. Int J Surg 2010; 8:2-5. [PMID: 19800432 DOI: 10.1016/j.ijsu.2009.09.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 09/26/2009] [Indexed: 10/20/2022]
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15
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Keiler S, Tyson P, Tamburro J. Metastatic cutaneous Crohn's disease in children: case report and review of the literature. Pediatr Dermatol 2009; 26:604-9. [PMID: 19840321 DOI: 10.1111/j.1525-1470.2008.00861.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Metastatic cutaneous Crohn's disease is a rare complication of Crohn's disease, especially in the pediatric population, and can present a diagnostic dilemma. Most of the reported cases of metastatic cutaneous Crohn's disease in childhood have concurrent gastrointestinal symptoms and/or perianal disease to aid in the diagnosis. We present a case of a 13 1/2-year-old girl whose initial symptom of Crohn's disease was asymptomatic labial swelling. An overview of metastatic cutaneous Crohn's disease in childhood is also provided.
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Affiliation(s)
- Susan Keiler
- Department of Dermatology, University Hospitals Case Western, Cleveland, Ohio, USA.
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16
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Palamaras I, El-Jabbour J, Pietropaolo N, Thomson P, Mann S, Robles W, Stevens HP. Metastatic Crohn's disease: a review. J Eur Acad Dermatol Venereol 2008; 22:1033-43. [DOI: 10.1111/j.1468-3083.2008.02741.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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17
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Graham DB, Tishon JR, Borum ML. An evaluation of vaginal symptoms in women with Crohn's disease. Dig Dis Sci 2008; 53:765-6. [PMID: 17764029 DOI: 10.1007/s10620-007-9921-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 07/04/2007] [Indexed: 12/09/2022]
Abstract
There are limited data available that address the prevalence of vaginal complaints in women with Crohn's disease. This study assessed the frequency of vaginal involvement and types of vaginal symptoms in women with Crohn's disease managed at a university inflammatory bowel disease program. The charts of 50 women with Crohn's disease seen consecutively during a three-month period were reviewed for the presence of vaginal involvement. The intestinal distribution of Crohn's disease [colonic, small bowel (SB), colonic/SB] was determined, and the presence of vaginal symptoms and types of complaints were assessed. Eleven of the 50 women (22%) described vaginal symptoms. Vaginal complaints included ten patients with labial swelling and one patient with passage of stool through the vagina. Nine of the 11 women with vaginal complaints also had concurrent intestinal symptoms and perineal manifestations (P < 0.001). This study suggests that vaginal involvement in Crohn's disease may be a more frequent phenomenon than previously reported.
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Affiliation(s)
- Deborah B Graham
- Division of Gastroenterology and Liver Diseases, The George Washington University Hospital, Washington, DC 20037, USA.
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18
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Abstract
Cutaneous Crohn disease refers to granulomatous skin manifestations not contiguous with gastrointestinal affected areas. It is a very rare condition, especially in children, and is easily misdiagnosed when characteristic gastrointestinal symptoms are absent. We report a 10-year-old Caucasian girl with a 6-month history of erythematous, firm tumescence of the left labium majus pudendi and moist vegetations circumscribing the anal ostium. Histologic analysis of skin biopsy specimens from both types of lesions showed a characteristic granulomatous noncaseating infiltrate throughout the dermis. Endoscopic examination and a colon biopsy specimen showed chronic granulomatous inflammation consistent with Crohn disease. Treatment with prednisolone 20 mg daily, metronidazole 250 mg three times daily, topical corticosteroids, and mupirocin ointment produced marked improvement of the vulvar edema, whereas the perianal lesion had a relapsing course. Early recognition of extra-intestinal manifestations of Crohn disease, which are extremely rare in children, may be difficult. Coexistence of contiguous and noncontiguous lesions, representing the very first signs of the disease, are further peculiarities in our patient.
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Affiliation(s)
- Anna Luisa Pinna
- Clinica Dermatologica - Università di Cagliari, Cagliari, Italy.
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19
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Porzionato A, Alaggio R, Aprile A. Perianal and vulvar Crohn's disease presenting as suspected abuse. Forensic Sci Int 2004; 155:24-7. [PMID: 16216708 DOI: 10.1016/j.forsciint.2004.10.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Accepted: 10/27/2004] [Indexed: 12/16/2022]
Abstract
Misdiagnosis of sexual abuse may arise in cases of vulvar and/or perianal diseases such as lichen sclerosus et atrophicus, Behcet's syndrome, bullous diseases, contact dermatitis, or neoplastic lesions. We present the case of a 7-year-old girl who was referred by her general paediatrician to the local hospital for perianal fissures and swelling of the labia majora. A report to the judicial authorities was made, for suspected sexual abuse, and the patient was transferred to the department of paediatric surgery. Here, histopathologic examination of vulvar and rectal biopsies revealed multiple non-caseating and non-confluent epithelioid-gigantocellular granulomas, consistent with a diagnosis of Crohn's disease, with cutaneous involvement of the genitalia. In cases of suspected sexual abuse, examination of children should be performed by a specialist in legal medicine in collaboration with a gynaecologist or paediatric surgeon. If the patient is hospitalised and the question of protection does not arise, physicians should exclude dermatological diseases before reporting to the judicial authorities.
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Affiliation(s)
- Andrea Porzionato
- Section of Legal Medicine, Department of Environmental Medicine and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
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20
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Saadah OI, Oliver MR, Bines JE, Stokes KB, Cameron DJS. Anorectal strictures and genital Crohn disease: an unusual clinical association. J Pediatr Gastroenterol Nutr 2003; 36:403-6. [PMID: 12604983 DOI: 10.1097/00005176-200303000-00020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Omar I Saadah
- Department of Gastroenterology, Royal Children's Hospital, Melbourne, Victoria, Australia
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21
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van de Scheur MR, van der Waal RIF, van der Waal I, Stoof TJ, van Deventer SJH. Ano-genital granulomatosis: the counterpart of oro-facial granulomatosis. J Eur Acad Dermatol Venereol 2003; 17:184-9. [PMID: 12705748 DOI: 10.1046/j.1468-3083.2003.00573.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ano-genital granulomatosis encompasses the previously recognized clinical entities of vulvitis granulomatosa, posthitis granulomatosa, and ano-perineitis granulomatosa. We report three patients with ano-genital granulomatosis. The pathological features of the disease are lymphoedema and the presence of non-caseating giant cell granulomas. These granulomas are histologically indistinguishable from those found in both Crohn's disease and sarcoidosis, therefore, patients with ano-genital granulomatosis with accompanying gastro-intestinal or pulmonary symptoms should be investigated for the presence of Crohn's disease or sarcoidosis, respectively. The value of ano-genital granulomatosis as a unifying clinicopathologic concept is to provide a label for the affliction as well as to stimulate a careful search for possibly underlying systemic disorders, thus also permitting a more specific approach to therapy.
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Affiliation(s)
- M R van de Scheur
- Department of Dermatology, Medical Centre Vrije Universiteit/ACTA, Amsterdam, The Netherlands.
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22
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Affiliation(s)
- N Nicolaou
- Department of Dermatology, Singleton Hospital, Swansea NHS Trust, UK.
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23
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Murphy MJ, Kogan B, Carlson JA. Granulomatous lymphangitis of the scrotum and penis. Report of a case and review of the literature of genital swelling with sarcoidal granulomatous inflammation. J Cutan Pathol 2001; 28:419-24. [PMID: 11493380 DOI: 10.1034/j.1600-0560.2001.028008419.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Acquired lymphedema of the genitalia is a rare childhood presentation and is more common in elderly individuals secondary to pelvic/abdomenal malignancy or its therapy or worldwide due to filariasis. OBJECTIVE Herein, we report a case of a healthy 11-year-old boy who presented with a 1-year history of chronic, asymptomatic scrotal and penile swelling. Biopsy revealed edema, lymphangiectases and peri- and intralymphatic sarcoidal type granulomas. This histologic pattern of granulomatous lymphangitis is most commonly associated with orofacial granulomatosis (granulomatous cheilitis and Melkersson-Rosenthal syndrome) and Crohn's disease. Treatment with topical steroids and physical support has resulted in marked improvement. No systemic disease (Crohn's disease) is evident 1 year later. Literature review revealed 44 cases of genital lymphedema with non-infectious granulomas. The majority of these young patients had Crohn's disease, frequently with anal involvement and a minority, both with and without Crohn's disease, had orofacial granulomatosis. CONCLUSIONS Granulomatous lymphangitis should be considered in the differential diagnosis of chronic idiopathic swelling of the genitalia, particularly in younger individuals. Further clinical examination, additional laboratory studies and close follow-up for co-existing or subsequent development of Crohn's disease should be performed. The overlap between granulomatous lymphangitis of the genitalia, Crohn's disease and orofacial granulomatosis suggest that granulomatous lymphangitis of the genitalia may represent a forme fruste of Crohn's disease.
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Affiliation(s)
- M J Murphy
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
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Bel Pla S, García-Patos Briones V, García Fernández D, Aparicio Español G, Castells Rodellas A. [Vulvar lymphedema: unusual manifestation of metastatic Crohn's disease]. GASTROENTEROLOGIA Y HEPATOLOGIA 2001; 24:297-9. [PMID: 11459566 DOI: 10.1016/s0210-5705(01)70178-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cutaneous-mucosal lesions constitute one of the most frequent extraintestinal manifestations of Crohn's disease and in some cases may be the first symptom of intestinal disease. We describe the case of a 45-year-old female patient who sought medical help for genital tumefaction of 20 years' evolution. For the previous 15 years, she had been experiencing digestive symptomatology attributed to irritable bowel syndrome. Two months before the consultation, and coinciding with aggravation of the condition, the patient had been diagnosed with colonic Crohn's disease. Skin biopsy of the labia minora revealed sarcoid granulomas. The results of microbiological studies (staining for microorganisms and cultures) were negative. A diagnosis of metastatic vulvar Crohn's disease was made and, treatment with metronidazole was started, which improved the genital edema after 2 months. Genital lymphedema is an exceptionally rare manifestation of metastatic Crohn's disease that may appear several years before intestinal symptomatology develops. Treatment with metronidazole seems to be a good therapeutic option.
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Affiliation(s)
- S Bel Pla
- Servicio de Dermatología. Hospital Universitari Vall dHebrón. Barcelona
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Leupold U, Horn LC, Witzigmann H, Pohl K, Mössner J, Keim V. [Vulvar involvement as a rare extra-intestinal manifestation of Crohn disease]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1998; 93:492-6. [PMID: 9747105 DOI: 10.1007/bf03042599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Crohn's disease may involve all parts of the gastrointestinal tract. Extraintestinal manifestations with and without continuity to the intestine are described. The most common complications are the involvement of bone (articulations), liver and eyes. Crohn's disease of the vulva is rare and only a few cases have been reported in the literature. CASE REPORT The 45-year-old woman has a 15-year history of a marked chronic-inflammatory bowel disease. The diagnosis of Crohn's disease was never confirmed histologically. In 1984, she developed a painful vulvar swelling and erythema. A fungal infection was suspected and she was treated with topical antimycotic medication, but there wasn't any improvement. In July 1995, biopsies of the vulva showed a granulomatous inflammation consistent with Crohn's disease. Oral metronidazol therapy (20 mg/kg/day) was started. After 2 months, the erythema had healed completely but the vulvar swelling remained. CONCLUSIONS The treatment of this extraintestinal manifestation is very difficult. Systemic or topical application of steroids is without response in most cases. Surgical excision showed good results in a few cases. A long-term treatment with oral metronidazol 20 mg/kg/day could be a chance for healing without adverse effects.
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Affiliation(s)
- U Leupold
- Abteilung Gastroenterologie und Hepatologie, Universität Leipzig
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Ploysangam T, Heubi JE, Eisen D, Balistreri WF, Lucky AW. Cutaneous Crohn's disease in children. J Am Acad Dermatol 1997; 36:697-704. [PMID: 9146530 DOI: 10.1016/s0190-9622(97)80320-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although cutaneous Crohn's disease is well recognized in adults, in children it is extremely rare. OBJECTIVE Our purpose was to describe five children with cutaneous Crohn's disease and to review the literature. METHODS The medical records of five children with cutaneous Crohn's disease were retrospectively reviewed for clinical features and laboratory data. An extensive review of the literature was conducted. RESULTS Five children, one boy and four girls, 6 to 12 years of age at onset, had cutaneous manifestations of Crohn's disease. Three had genital swelling, and the other 2 had buttock abscesses. Most were seen before the diagnosis of gastrointestinal Crohn's disease was made. There have been 80 cases of cutaneous Crohn's disease described, including our series. Only 14 were in children. Two thirds of children with cutaneous Crohn's disease had genital involvement compared with about half of the adult cases. Sixteen of the 80 patients had cutaneous lesions without preceding gastrointestinal Crohn's disease. Of these, approximately 70% had genital lesions. CONCLUSION Although Crohn's disease is common in children, cutaneous manifestations are rarely a presenting sign. However, when cutaneous Crohn's disease is present in children, it commonly precedes the gastrointestinal disease.
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Affiliation(s)
- T Ploysangam
- Department of Dermatology, University of Cincinnati Medical Center, OH, USA
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Abstract
Four patients with chronic vulval inflammation are described. The histological features of non-caseating granulomata and multinucleated giant cells are compatible with Crohn's disease, but only two patients had proven gastrointestinal involvement. The clinical and histological characteristics of Crohn's disease and other granulomatous inflammations of the vulva are discussed and the literature is reviewed.
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Affiliation(s)
- M Urbanek
- Department of Dermatology, St Peter's Hospital, Chertsey, Surrey, UK
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Price LM, Mendelsohn SS, Youngs GR, O'Mahony CP. Unilateral vulval hypertrophy and Crohn's disease. Int J STD AIDS 1995; 6:146. [PMID: 7779932 DOI: 10.1177/095646249500600221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Pattison RM, O'donnell MA, Moss ALH. Surgical treatment of vulval ‘polyps’ in Crohn's disease. J OBSTET GYNAECOL 1994. [DOI: 10.3109/01443619409004079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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