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Gomolin A, Zargham H, Sant'Anna AM, Lovett A. Vulvar swelling and the timely diagnosis of Crohn's disease: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211008627. [PMID: 33889413 PMCID: PMC8040378 DOI: 10.1177/2050313x211008627] [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] [Indexed: 11/29/2022] Open
Abstract
Children with vulvar swelling often present to multiple physicians and face a prolonged period of ambiguity and extraneous treatments. Here, we report a case of an 8-year-old girl who presented to the dermatology clinic with a 2-month history of vulvar swelling and was ultimately diagnosed with Crohn’s disease. Although extra-intestinal manifestations are common in inflammatory bowel diseases, they rarely present before an existing diagnosis. This report highlights this potential early manifestation and demonstrates how timely diagnosis leads to improved outcomes for patients, their families, and healthcare systems.
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Affiliation(s)
| | | | - Ana Maria Sant'Anna
- McGill University, Montreal, QC, Canada.,Division of Gastroenterology and Nutrition, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Audrey Lovett
- McGill University, Montreal, QC, Canada.,Division of Allergy, Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
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2
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Mauskar MM, Marathe K, Venkatesan A, Schlosser BJ, Edwards L. Vulvar diseases. J Am Acad Dermatol 2020; 82:1287-1298. [DOI: 10.1016/j.jaad.2019.10.077] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/26/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022]
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3
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Riegert M, Peebles JK, O'Connell DM, Arkin LM. Visual Diagnosis: A 7-year-old Girl with Labial Edema and Decreased Growth Velocity. Pediatr Rev 2018; 39:e57-e59. [PMID: 30504258 DOI: 10.1542/pir.2017-0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Maureen Riegert
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Daniel M O'Connell
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Lisa M Arkin
- Department of Dermatology.,Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
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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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5
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Affiliation(s)
- Megan S Evans
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul B Googe
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dean S Morrell
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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6
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Dederichs F, Iesalnieks I, Sladek M, Tzivinikos C, Hansen R, Muñoz C, Pavli P, Cavicchi M, Abitbol V, Rahier JF, Vavricka S, Katsanos K, Domènech E. Genital Granulomatosis in Male and Female Patients With Crohn's Disease: Clinical Presentation and Treatment Outcomes. J Crohns Colitis 2018; 12:197-203. [PMID: 29029098 DOI: 10.1093/ecco-jcc/jjx131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 09/16/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Genital granulomatosis [GG] is a metastatic form of Crohn's disease [CD], characterised by granulomatous inflammation of the genital skin without contact with the gastrointestinal tract. Little is known about GG, as most publications are case reports or small series, and only sporadic in male cases. METHODS AND AIMS Cases of GG were retrospectively collected through the Collaborative Network For Exceptionally Rare case reports project of the European Crohn's and Colitis Organisation. RESULTS A total of 43 patients [9 males, 34 females] were diagnosed as having GG, mostly as oedema and/or ulcers. Histological confirmation of granulomas was obtained in 70% of the cases. CD location was colonic or ileocolonic in 97% and perianal disease was documented in 57%. There was no significant difference between males and females in CD phenotype or genital lesions. GG was the first manifestation of inflammatory bowel disease [IBD] in one-third of the patients; these patients were younger at the time of GG occurrence and they all were non-smokers. GG occurred in the absence of gastrointestinal disease activity in 30% of the cases. Ten out of 11 patients [91%] responded to systemic corticosteroid treatment, 5/9 patients responded to immunomodulators, and 9/11 patients responded to anti-tumour necrosis factor alpha [TNF-α] agents. CONCLUSIONS GG is a rare extraintestinal manifestation of CD. It mainly occurs among women, in the setting of colonic involvement of CD, and perianal disease is often associated. Most cases are successfully managed with systemic corticosteroids or anti-TNF agents.
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Affiliation(s)
| | | | | | | | | | - Carmen Muñoz
- Villafranca del Hospital Universitario de Basurto, Bilbao, Spain
| | | | | | | | | | | | | | - Eugeni Domènech
- Hospital Universitari Germans Trias i Pujol, Badalona, and CIBEREHD, Madrid, Spain
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Ahad T, Riley A, Martindale E, von Bremen B, Owen C. Vulvar swelling as the first presentation of Crohn's disease in children-A report of three cases. Pediatr Dermatol 2018; 35:e1-e4. [PMID: 29159956 DOI: 10.1111/pde.13272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Vulvar swelling is a rare manifestation of metastatic Crohn's disease in children. It often predates gastrointestinal symptoms and can be the first presentation of pediatric Crohn's disease. We report three cases of pediatric Crohn's disease presenting with vulvar swelling. We discuss this rare presentation and its treatment and highlight the importance of recognizing it so that prompt investigation and appropriate management can be initiated.
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Affiliation(s)
- Tashmeeta Ahad
- Department of Dermatology Salford Royal National Health Service Foundation Trust, Salford, UK
| | - Anna Riley
- The Rothbury Practice, Rothbury, Northumberland, UK
| | | | - Beate von Bremen
- Department of Obstetrics and Gynaecology, East Lancashire Hospitals Trust, UK
| | - Caroline Owen
- Department of Dermatology, East Lancashire Hospitals Trust, UK
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Granese R, Calagna G, Morabito G, Carriero C, Perino A, Tonni G, Romano C. Vulvar involvement in pediatric Crohn's disease: a systematic review. Arch Gynecol Obstet 2017; 297:3-11. [PMID: 28948431 DOI: 10.1007/s00404-017-4539-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/19/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE The aim of the study is to report a systematic review (from 2000 to 2017) of all pediatric cases of vulvar Crohn's disease (VCD) and to highlight the key-points for a correct diagnosis and management of this rare condition. METHODS An electronic search using the Pubmed/Medline, Scopus, EMBASE, Cochrane database and Google Scholar database was performed according to PRISMA guidelines. RESULTS Twenty pediatric studies and 22 cases of VCD were included for analysis. All the articles reported a single case, except two articles where two cases, respectively, are described. Clinical vulvar examination showed the following main manifestations: vulvar erythema (9/22 cases, 40.9%), vulvar swelling (8/22 cases, 36.4%), vulvar edema (8/22 cases, 36.4%), vulvar ulcers (4/22 cases, 18.2%). Perianal and/or anal involvement (fissures, vegetations, skin tags, erythema, papules, nodules) were recorded in ten cases (45.4%). Steroids per os and/or topical administration were the most prescribed treatment, achieving clinical remission in 11 cases (50%), used alone or in combination with metronidazole or 5-aminosalicylic acid, azathioprine or sulphasalazine/mesalazine. CONCLUSIONS This review shows that pediatric VCD is an uncommon disease, difficult to be diagnosed as either symptoms or clinical lesions are not specific. A multidisciplinary approach is advised to reach a correct diagnosis and plan clinical treatment.
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Affiliation(s)
- Roberta Granese
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood "G. Barresi", University Hospital "G. Martino", via Consolare Valeria, Gazzi, Messina, Italy.
| | - Gloria Calagna
- Department of Gynecology and Obstetrics, "Villa Sofia Cervello" Hospital, University of Palermo, via Trabucco 180, Palermo, Italy
| | - Giuliana Morabito
- Gastroenterology Unit, Department of Human Pathology of Adult and Childhood "G. Barresi", University Hospital "G. Martino", via Consolare Valeria, Gazzi, Messina, Italy
| | - Carmine Carriero
- Department of Gynecology and Obstetrics, University Hospital of Bari, via Aldo Moro, Bari, Italy
| | - Antonio Perino
- Department of Gynecology and Obstetrics, "Villa Sofia Cervello" Hospital, University of Palermo, via Trabucco 180, Palermo, Italy
| | - Gabriele Tonni
- Department of Obstetrics and Gynecology, Guastalla Civil Hospital, ASL Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Romano
- Gastroenterology Unit, Department of Human Pathology of Adult and Childhood "G. Barresi", University Hospital "G. Martino", via Consolare Valeria, Gazzi, Messina, Italy
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Schlak A, Greenfield K, Crewe S, Lee CC. Abnormal Findings Lead to Surprising Diagnosis. Clin Pediatr (Phila) 2017; 56:402-404. [PMID: 27169715 DOI: 10.1177/0009922816649002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Amanda Schlak
- 1 Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | | | | | - Clifton C Lee
- 1 Children's Hospital of Richmond at VCU, Richmond, VA, USA
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10
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Lynch M, Byrne B, Ramsay B. Anogenital Swelling in a Teenager. Pediatr Dermatol 2016; 33:553-4. [PMID: 27595873 DOI: 10.1111/pde.12921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maeve Lynch
- Dermatology Department, University Hospital Limerick, Dooradoyle, County Limerick, Ireland.
| | - Berbie Byrne
- Dermatology Department, University Hospital Limerick, Dooradoyle, County Limerick, Ireland
| | - Bart Ramsay
- Dermatology Department, University Hospital Limerick, Dooradoyle, County Limerick, Ireland
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Lamberti A, Filippou G, Adinolfi A, Fimiani M, Rubegni P. Infantile perianal pyramidal protrusion: a case report with dermoscopy and ultrasound findings. Dermatol Pract Concept 2015; 5:125-8. [PMID: 26114069 PMCID: PMC4462916 DOI: 10.5826/dpc.0502a25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/28/2014] [Indexed: 01/02/2023] Open
Abstract
Infantile perianal pyramidal protrusion, it is a rare benign cutaneous condition described in relatively recent times. It is considered to be under-reported in the pediatric literature because it is often mistaken for other conditions. The unawareness of this lesion may be responsible for an excessive concern both in physician and in parents, which leads to overly aggressive and unnecessary treatments. Thus its recognition has many implications regarding proper management and treatment. We report a typical presentation of IPPP in which the diagnosis was based on the use of non-invasive diagnostic tools and in particular of dermoscopy and ultrasonography.
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Affiliation(s)
- Arianna Lamberti
- Department of Medicine, Surgery and Neurosciences, Dermatology Section, University of Siena, Italy
| | - Georgios Filippou
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Italy
| | - Antonella Adinolfi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Italy
| | - Michele Fimiani
- Department of Medicine, Surgery and Neurosciences, Dermatology Section, University of Siena, Italy
| | - Pietro Rubegni
- Department of Medicine, Surgery and Neurosciences, Dermatology Section, University of Siena, Italy
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Bouzidi H, Chakiri R, Amraoui N, Krich S, Mernissi FZ, Belmahi R, Hida M. Crohn's disease presenting as vulvar edema in a 15-year-old girl. J Dermatol Case Rep 2014; 8:75-7. [PMID: 25324909 DOI: 10.3315/jdcr.2014.1180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 06/20/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Vulval involvement is an uncommon extraintestinal manifestation of Crohn's disease, and it is very rare in children. Patients with vulval CD typically present with erythema and edema of the labia majora, which can progresses to extensive ulcer formation. Vulval CD can appear before or after intestinal problems or it may occur simultaneously. OBSERVATION We present a 15-years-old girl with bilateral labial hypertrophy which revealed a Crohn's disease. The course of her lesion was independent of the intestinal disease and responded significantly to medical treatment including Mesalamine, corticosteroid and local care. CONCLUSIONS We emphasize that although vulval involvement in childhood is uncommon, Crohn's disease must be considered in the differential diagnosis of nontender, red, edematous lesions of the genital area.
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Affiliation(s)
- Hanae Bouzidi
- Department of Dermatology, Hassan II University Hospital, Fes, Morocco
| | - Radia Chakiri
- Department of Dermatology, Hassan II University Hospital, Fes, Morocco
| | - Nissrine Amraoui
- Department of Dermatology, Hassan II University Hospital, Fes, Morocco
| | - Sanae Krich
- Department of Dermatology, Hassan II University Hospital, Fes, Morocco
| | | | - Rajae Belmahi
- Department of Pediatrics, Hassan II University Hospital, Fes, Morocco
| | - Moustapha Hida
- Department of Pediatrics, Hassan II University Hospital, Fes, Morocco
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Kempeneers C, Paquot I, Philippet P, Goossens A, Bernier V. Sterile folliculitis as an important diagnostic clue to Crohn's disease. Pediatr Dermatol 2013; 30:e146-8. [PMID: 23017081 DOI: 10.1111/j.1525-1470.2012.01796.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sterile folliculitis is known to be one of the rare cutaneous manifestations of Crohn's disease (CD). To our knowledge it has never been emphasized as a marker of significant diagnostic value, perhaps maybe even more significant than more common cutaneous manifestations such as erythema nodosum (EN).
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Affiliation(s)
- Céline Kempeneers
- Department of Pediatrics, CHC, Clinique de l'Espérance, LiègeSector of Pediatric Gastroenterology, Department of Pediatrics, CHC, Clinique de l'Espérance, LiègeDepartment of Anatomopathology, UZ-Brussel, BrusselsSector of Pediatric Dermatology, Department of Pediatrics, CHC, Clinique de l'Espérance, Liège, Belgium
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14
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Affiliation(s)
- Kristina R Burke
- Walter Reed National Military Medical Center, Bethesda, MD 20816, USA.
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Abstract
Although Crohn disease (CD) is considered an inflammatory bowel disease, extraintestinal gynecologic manifestations are varied, frequent, and oftentimes difficult to manage. Its predilection for young and reproductive-age women makes it an important disease process for the gynecologist to understand, as its complications can have long-term repercussions on the developmental, sexual, reproductive, and psychological health of affected women. Patients may present with a variety of vulvovaginal, perineal, perianal, and urologic complaints. Perianal involvement from an intestinal fistula is the most common skin manifestation seen in CD. Other gynecologic manifestations include metastatic CD and rectovaginal and urovaginal fistulas. Recognition and accurate diagnosis of extraintestinal gynecologic manifestations, as well as a good understanding of the gynecologic effects of chronic disease, are necessary for optimal management. The article provides an overview of CD and highlights the gynecologic considerations in caring for women affected by this disease.
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Zabetian S, Lowe L, Shwayder T. An adolescent boy with persistent penile and scrotal erythema and swelling. Pediatr Dermatol 2012; 29:765-6. [PMID: 23106677 DOI: 10.1111/j.1525-1470.2011.01705.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Saba Zabetian
- Wayne State University School of Medicine, Detroit, Michigan, USA
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Asymptomatic granulomatous vulvitis and granulomatous cheilitis in childhood: the need for Crohn disease workup. J Pediatr Gastroenterol Nutr 2011; 53:100-1. [PMID: 21694543 DOI: 10.1097/mpg.0b013e31820bcff9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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