Revisão sistemática e meta-análise das tendências de frequência e reclassificação da doença inflamatória pediátrica intestinal - não classificadas / Systematic review and meta - analysis of the frequency and re-classification trends of pediatric inflammatory bowel disease - unclassified

ABSTRACT Background: The term inflammatory bowel disease-unclassified (IBDU) is used when an individual has chronic colitis but cannot be sub-typed into ulcerative colitis (UC) or Crohn's disease (CD) on the basis of the clinical, endoscopic, imaging and histopathological features. On follow-up a proportion of patients with IBDU are re-classified as CD or UC. There has been considerable variability in the frequency and reclassification rates of pediatric IBDU in published literature. Methods: PubMed and Scopus and were searched for publications related to Pediatric Inflammatory Bowel Disease (PIBD) published between Jan,2014 and July,2021. Two reviewers independently searched and selected studies reporting the frequency of IBDU and/or their re-classification. The pooled prevalence was expressed as proportion and 95%CI. Meta-analysis was performed using the inverse variance heterogeneity model. Results: A total of 2750 studies were identified through a systematic search of which 27 studies were included in this systematic review. The overall pooled frequency of IBDU (n=16064) was found to be 7.1% (95%CI 5.8-8.5%). There was no variation in IBDU frequency by geographical location. Seven studies (n=5880) were included in the IBDU re-classification analysis. Overall, 50% (95%CI 41-60%) children with IBDU were re-classified on follow-up. Amongst these 32.7% (95% 21-44%) were re-classified to UC and 17% (95%CI 12-22%) were re-classified to CD. Conclusion: IBDU comprises 7.1% of PIBD at initial diagnosis. Half of these children are re-classified into UC or CD on follow-up with a higher likelihood of re-classification to UC as compared to CD.

RESUMO Contexto: O termo doença inflamatória intestinal não classificada (DIINC) é usado quando um indivíduo tem colite crônica, mas não pode ser sub tipificado em colite ulcerativa (UC) ou doença de Crohn (DC) com base nas características clínicas, endoscópicas, de imagem e histopatológicas. No acompanhamento, uma proporção de pacientes com DIINC são reclassificadas como DC ou UC. Houve considerável variabilidade nas taxas de frequência e reclassificação de DIINC pediátrico na literatura publicada. Métodos: Foram procuradas publicações no PubMed e Scopus relacionadas à doença inflamatória pediátrica intestinal publicadas entre janeiro de 2014 e julho de 2021. Dois revisores pesquisaram e selecionaram estudos independentemente relatando a frequência da DIINC e/ou sua reclassificação. A prevalência agrupada foi expressa em proporção e para IC95%. A meta-análise foi realizada utilizando o modelo de heterogeneidade de variância inversa. Resultados: Foram identificados 2.750 estudos por meio de uma busca sistemática, dos quais 27 estudos foram incluídos nesta revisão sistemática. A frequência total agrupada da DIINC (n=16064) foi de 7,1% (IC95% 5,8-8,5%). Não houve variação na frequência da DIINC por localização geográfica. Sete estudos (n=5880) foram incluídos na análise de reclassificação da DIINC. No geral, 50% (IC95% 41-60%) foram reclassificadas no seguimento. Entre esses 32,7% (95% 21-44%) foram reclassificados para UC e 17% (IC95%12-22%) foram reclassificados para DC. Conclusão: DIINC compreende 7,1% da doença inflamatória pediátrica intestinal no diagnóstico inicial. Metade dessas crianças são reclassificados em UC ou DC no seguimento com maior probabilidade de reclassificação para UC em comparação com o DC.

Manifestações do trato gastrointestinal superior em pacientes com doença inflamatória intestinal atendidos em serviço de referência em Salvador - BA / Upper gastrointestinal tract manifestations in inflammatory bowel disease patients from one reference service in Salvador - BA

Introdução: a Doença Inflamatória Intestinal (DII) se manifesta em duas principais formas: doença de Crohn (DC) e retocolite ulcerativa (RCU). O quadro clínico clássico da DII compreende dor abdominal, diarreia e perda ponderal. Além da apresentação habitual, os pacientes podem apresentar, no decorrer da doença, manifestações do trato gastrointestinal superior (TGS) como: dispepsia, dor epigástrica, plenitude pós-prandial, pirose, náuseas, regurgitação, aftas orais, vômitos, disfagia, odinofagia e hematêmese. Objetivo: descrever as manifestações do TGS em pacientes com DII em um centro de referência da Bahia. Métodos: estudo transversal realizado no período de julho de 2015 a agosto de 2016 no ambulatório de DII do Hospital Geral Roberto Santos (HGRS). A coleta de dados foi por um questionário objetivo e revisão de prontuários. Foram avaliadas variáveis do ponto de vista epidemiológico e clínico. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital Geral Roberto Santos. As variáveis foram analisadas utilizando o pacote estatístico SPSS versão 21.0. Resultados: foram incluídos 306 pacientes. O sexo feminino foi mais prevalente tanto na DC (63,1%) quanto na RCU (60,6%). Dos 306 pacientes analisados, 141 tinham diagnóstico de DC e 165 tinham diagnóstico de RCU. Da amostra total, 58,5% apresentaram alguma manifestação do TGS, sendo a frequência semelhante entre DC e RCU. Conclusões: mais da metade dos pacientes com DII apresentou pelo menos uma manifestação do TGS, sendo que as manifestações mais frequentes foram: pirose, dor epigástrica, dispepsia e plenitude pós-prandial. DC e RCU apresentaram frequências semelhantes dessas manifestações. Estes sintomas devem ser atentamente questionados, pois é fundamental o seu reconhecimento precoce para o manejo adequado.

Introduction: inflammatory Bowel Disease (IBD) manifests itself in two main forms: Crohns disease (CD) and ulcerative colitis (UC). The classic clinical presentation of IBD includes abdominal pain, diarrhea and weight loss. In addition to the usual presentation, patients may presente upper gastrointestinal tract (UGT) manifestations such as: dyspepsia, epigastric pain, postprandial fullness, heartburn, nausea, regurgitation, oral thrush, vomiting, dysphagia, odynophagia and hematemesis. Objective: to describe the manifestations of the UGT in patients with IBD at a reference center in Bahia. Methods: a cross-sectional study conducted from July 2015 to August 2016 at the Hospital Geral Roberto Santos (HGRS) - IBD unit. Data collection was made by an objective questionnaire and review of medical records. Variables from epidemiological and clinical point of view were evaluated. The study was approved by the Research Ethics Committee of the HGRS (Salvador - BA). Variables were analyzed using the statistical package SPSS version 21.0. Results: we evaluated 306 patients. Female gender was more prevalent in both CD (63.1%) and UC (60.6%). Of the 306 patients analyzed, 141 had been diagnosed with CD and 167 with UC. Of the total sample, 58.5% had some manifestation of the UGT, being similar between CD and UC. Conclusion: more than half of patients with IBD presented at least one manifestation of the UGT, and the most frequent were: heartburn, epigastric pain, dyspepsia and postprandial fullness. CD and UC presented similar frequencies of these manifestations. These symptoms should be carefully questioned, as it is fundamental their early recognition for the adequate management of these patients.

Doença de Crohn associada a tumor carcinoide gástrico: relato de caso e revisão de literatura / Crohns disease associated with gastric carcinoid tumor: a case report and literature review

Os tumores carcinoides gástricos são neoplasias raras, derivadas das células enterocromafins e podem associar-se a doenças inflamatórias intestinais, como a doença de Crohn. Atualmente, há aumento da incidência devido a maior realização de endoscopia digestiva alta. A abordagem depende do tipo, tamanho e número de lesões, além da presença de metástases. Este é o relato de caso de um paciente com doença de Crohn associada a tumor carcinoide gástrico.

The gastric carcinoid tumors are rare, derived from the enterochromaffin cells and may be associated with inflammatory bowel diseases such as Crohns disease. Currently, there is increased incidence due to higher performing endoscopy. The approach depends on the type, size, number of lesions and the presence of metastases. This is a case report of a patient with Crohns disease associated with gastric carcinoid tumor.

Associação de doença inflamatória intestinal com ansiedade e depressão: avaliação dos fatores de risco / Inflammatory bowel disease and association with anxiety and depression: evaluation of the risk factors

Contexto: Doenças Inflamatórias Intestinais - DII (Doença de Crohn - DC e Retocolite Ulcerativa - RCU) - são desordens crônicas, de etiologia indefinida, de curso imprevisível, com necessidade de tratamento a longo prazo. Por vários fatores, estão associadas a sintomas psicológicos e estigmatização dos portadores. Objetivo: estimar a prevalência de ansiedade e depressão nos pacientes acompanhados em hospital universitário de Pernambuco e avaliar a relação com gênero, faixa etária, estado civil, gravidade, tipo e duração da doença, além de internamentos ou cirurgias prévias. Método: estudo transversal realizado no Hospital das Clínicas da Universidade Federal de Pernambuco, com coleta de dados de maio a setembro de 2013. Foi utilizada a Escala Hospitalar de Ansiedade e Depressão (HAD). Resultados: participaram do estudo 82 pacientes. Ansiedade e depressão foram diagnosticadas em 42 (51,2%) e 31 (37,8%), respectivamente. Obteve-se maior prevalência em mulheres (61,4% e 41,5%), casados (55,3% e 42,6%), portadores de Doença de Crohn (52,4% e 38,1%), com atividade moderada/grave (58,3% e 58,3%), diagnóstico há mais de dez anos (59,3% e 48,1%), com internamento prévio (58,1% e 44,2%). Encontrou-se associação significativamente estatística entre ansiedade e sexo feminino (p=0,025) e entre depressão e atividade da doença (p=0,025). Conclusão: a prevalência de ansiedade e depressão no grupo populacional estudado foi compatível com a literatura. O sexo feminino esteve relacionado significativamente à maior prevalência de ansiedade, bem como a gravidade da doença esteve relacionada à depressão.

Background: Inflammatory Bowel Diseases (IBD): Crohn's disease (CD) and Ulcerative Colitis (UC) are chronic disorders of unknown etiology, unpredictable course, requiring long term treatment. For many reasons, they are associated with psychological symptoms and stigmatizations of the patients. Purpose: to estimate the prevalence of anxiety and depression among the patients treated at a university hospital in Pernambuco and evaluate the relationship with gender, age, marital status, severity, type and duration of the disease and previous surgeries or hospitalizations. Material and methods: this is a cross-sectional study performed at Clinic Hospital of the Federal University of Pernambuco, from May to September 2013. Questionnaires to assess anxiety and depression were used by the Hospital Anxiety and Depression Scale (HAD). Results: the study included 82 patients. Anxiety and depression were diagnosed in 42 (51.2%) and 31 (37.8%) of them, respectively. There was a higher prevalence among women (61.4% and 41.5%), married (55.3% and 42.6%), patients with Crohn's disease (52.4% and 38.1%), with moderate/severe activity (58.3% and 58.3%), diagnosed for more than ten years (59.3% and 48.1%), with previous hospitalization (58.1% and 44.2%). It was found a significant association between anxiety and females (p=0.025) and between depression and a moderate/severe disease activity (p=0.025). Conclusion: the prevalence of anxiety and depression in this study was consistent with the literature. Females were significantly related to higher prevalence of anxiety as disease severity was related to depression.

Diagnóstico diferencial entre doença de crohn e hidradenite supurativa: relato de caso / Differential diagnosis between crohn's disease and hidradenitis supurativa: case report

A doença de Crohn é uma doença inflamatória intestinal crônica com inflamação transmural segmentar, que pode complicar com formação de fístulas e abscessos. A hidradenite supurativa (HS) é caracterizada por abscessos recorrentes e dolorosos, com predileção por áreas ricas em glândulas apócrinas como as regiões axilares, inguinais e perineal. O diagnóstico diferencial entre estas doenças é difícil e pode comprometer o tratamento. Relatamos o caso de C.R.M.A., 40 anos, feminina, branca, com doença de Crohn íleocolônica com fístula perianal e retovaginal há 12 anos, em terapia biológica desde maio 2010. Em setembro de 2010 apresentou abscesso em glúteo direito com saída de secreção purulenta refratária ao uso de ciprofloxacino e metronidazol. Ultrassonografia apresentando coleção de 30 cm3 em região glútea direita. A hipótese diagnóstica foi HS e a paciente foi submetida à ressecção cirúrgica em bloco (10 x 2 cm), com cicatrização por segunda intenção. Realizou enxerto de pele em dezembro de 2010 sem sucesso. Retornou em janeiro de 2011 com nova fístula no local da ressecção, compatível com doença de Crohn. Em fevereiro de 2011 foi submetida à drenagem dos abscessos e colocação de setons nas fístulas perianais. Atualmente em terapia biológica, com boa evolução das fístulas. A prevalência da HS varia de 0,3 a 4% da população em geral. A axila é a região mais afetada e as lesões perianais estão associadas com maior debilidade. Há relatos na literatura de associação entre a HS e a doença de Crohn de forma esporádica, e novos estudos são necessários para avaliar uma patogênese em comum. O diagnóstico diferencial deve ser realizado em todos os casos para tratamento imediato, evitando-se, assim, as complicações e a piora da qualidade de vida do doente.

Crohn?s disease is a chronic inflammatory bowel disease with segmental transmural inflammation, which complicate with formation of fistulas and abscesses. The hidradenitis suppurativa (HS) is characterized by recurrent abscesses, with a predilection for areas rich in apocrine glands such as the axillary, inguinal and perineal. The differential diagnosis between these diseases is difficult and may compromise treatment. Report case: C.R.M.A., 40 year-old, female, white, ileal and colonic Crohn?s disease complicated with perianal and rectovaginal fistula for 12 years, treated with biological therapy since May 2010. In Sep/2010 presented with an abscess in the buttock D with purulent discharge refractory to the use of ciprofloxacin and metronidazole. USG: collection of 30 cm3 in buttock D. The diagnosis was HS and the patient underwent extensive surgical removal of the affected areas (10 x 2 cm) with healing by secondary intention. Skin graft performed unsuccessfully in Dec/2010. The patient returned in jan/2011 with a new fistula at the site of resection, consistent with Crohn?s disease. In fev/2011 underwent drainage of abscesses and placement of setons in perianal fistulas. Currently in therapy with good biological evolution of fistulas. The prevalence of HS varies from 0.3 to 4% of the population in general. The axilla is the region most affected and perianal lesions are associated with greater weakness. There are published reports of association between HS and Crohn?s disease sporadically and further studies are needed to assess a common pathogenesis. The differential diagnosis should be performed in all cases planning immediate treatment, avoiding complications and worsening of the patient?s quality of life.

Tratamento não operatório de hemobilia por ferimento de arma branca: relato de caso / Non-operative management of hemobilia for penetrating abdominal trauma: case report

A hemobilia ocorre quando doenças ou injúrias causam comunicação entre o sangue de vasos intra-hepáticos com o trato biliar. O diagnóstico de hemobilia foi apresentado pela primeira vez por Francis Glisson em 1654, porém o primeiro caso documentado data de 1777 por Antoni Portal. O objetivo do presente relato é apresentar um caso de hemobilia em paciente atendido no Hospital Universitário de Maringá por ferimento de arma branca que apresentou tardiamente hemorragia digestiva alta e diagnosticado hemobilia submetido a tratamento não operatório.

Hemobilia occurs when injury or disease cause comunication between intrahepatic blood vessel and the biliary tract. Francis Glisson introduced the diagnosis of hemobilia in 1654, but Antoine Portal documented the first case in 1777. The aim of this report is to present a case of late presentation of hepatic pseudoaneurysm with hemobilia for penetrating abdominal trauma submeted a non-operative management of hemobilia at the Hospital of Maringá State University.

Adherent Escherichia coli in colorectal mucosal biopsies: A histological and ultrastructural evaluation.

Background: Colorectal mucosal biopsies occasionally demonstrate the presence of bacteria adherent to the epithelium. This study evaluated the histological and ultrastructural correlates of such bacterial adherence. Materials and Methods: Rectal mucosal biopsies from eight patients in whom histopathological examination of biopsies had earlier demonstrated adherent bacteria were examined by electron microscopy and by bacterial culture. Colorectal biopsies of 69 patients with adherent bacteria detected histologically were retrospectively evaluated for histological changes at sites proximal and distant to adherent bacteria. Results: Escherichia coli of different serogroups were isolated from 7 of 8 rectal biopsies demonstrating bacterial adherence. All isolates showed diffuse or focal adherence to HEp-2 cell monolayers. Ultrastructural changes noted included microvillus damage, pedestal formation, actin web condensation, and protrusions of the apical cytoplasm of epithelial cells into the lumen towards the bacteria. Histological changes noted at light microscopy included reduction in epithelial cell height, focal epithelial cell degeneration, cryptitis and neutrophil infiltration at sites of bacterial adherence whereas these were usually absent at sites distant to adherent bacteria. Bacterial adherence was noted more often in biopsies from Crohn's disease patients than in patients without this diagnosis (P < 0.001). Conclusion: Adherent Escherichia coli in colorectal biopsies were associated with focal epithelial damage and showed an association with Crohn's disease.

Avaliação da resposta terapêutica ao infliximabe em pacientes com Doença de Crohn / Evaluation of infliximab treatment for Crohns Disease pacients

Introdução: infliximabe representa grande avanço no tratamento da Doença de Crohn refratária, demonstrada em ensaios clínicos, tanto no regime de indução quanto em manutenção. Objetivo: avaliar o tratamento com infliximabe, estudando sua eficácia, apontando possíveis fatores preditivos de resposta e, por fim, descrevendo possíveis reações adversas registradas. Resultados: após a indução, 86,1% dos pacientes responderam ao tratamento; na 54ª semana de manutenção, 88,9%. Descontinuaram corticosteroides, 83,4%. Ao final da avaliação, 83,4% estavam em remissão de doença. Discussão: as frequências de resposta foram maiores em relação aos ensaios clínicos, no entanto, semelhantes em relação aos trabalhos mais recentes, retrospectivos e prospectivos. Não foram encontrados fatores preditivos de resposta. As respostas de pacientes com Doença de Crohn ativa e fistulizante foram semelhantes. Um pequeno número de pacientes (05) apresentou efeitos adversos atribuíveis ao medicamento, porém nenhum precisou interromper ou suspender tratamento. Conclusão: o infliximabe foi efetivo e seguro entre os pacientes com Doença de Crohn ativa e fistulizante.

Introduction: infliximab represents a great advance in refractory Crohns Disease treatment, showed in clinical trials, for induction as well as for maintenance therapy. Aim: evaluate the infliximab treatment, studying its efficacy, pointing possible predictive factor of response, and describing register collateral effects. Results: after induction, 86.1% of the patients improved with the treatment; 88.9% improved with maintenance therapy at week 54. 83.4% were able to discontinue corticosteroids. By the end of the evaluation, 83.4% were in clinical remission. Discussion: however, the response was superior when compared to the clinical trials; it was similar to more recent studies. It was not found any predictors of response to infliximab. A small number of patients reported side effects possibly associated with the drug, but none of them needed to discontinue treatment. Conclusion: the infliximab was effective and safe among patients with active and fistulizing Crohns Disease.

Clinical and endoscopic diagnosis in the differentiation of Crohn's disease from intestinal tuberculosis / 中华消化杂志

Objective To compare the clinical features and endoscopic findings of Crohn's disease(CD) and intestinal tuberculosis(ITB) in order to differentiate CD from ITB. Methods The clinical and endoscopic data from 168 patients with CD and 156 patients with ITB between June 2003 and February 2009 were retrospectively analyzed. Results The salient features of CD were male patients in predominance (male : female was 108 :60) and high incidence of colectomy (CD 33.3% vs ITB 10.9%, P<0.01). Diarrhea (66.1%), hematochezia (32.1%), perianal disease (16.1%), intestinal obstruction (28.0%) were more frequent in CD patients than in ITB patients (47.0%, 7.7%, 3.4%, 9.4% respectively, all P values<0.05). The salient features of ITB were night sweating, pulmonary tuberculosis, ascites, hyperglobulin, increased erythrocyte sedimentation rate and the positive serum antibody to mycobacterium. The endoscopic examination showed that the fissure-shape ulcer, grid-shape ulcer, cobblestone sign and intestinal stricture were more frequent in CD patients than in ITB patients (all P values <0.05). Whereas the circular ulcer and involved ileocecal valve with fixed bouche shape were more common in ITB patients (P<0.05). Conclusions The clinical characteristics are different in CD and ITB patients. The endoscopic findings including fissure-shape ulcer, grid-shape ulcer, circular ulcer, cobblestone sign and the status of involved ileocecal valve are important in the differentiation of ITB from CD.

Queilite granulomatosa associada à síndrome de Melkersson-Rosenthal / Cheilitis granulomatosa associated with melkersson-rosenthal syndrome

A síndrome de Melkerson-Rosenthal (SMR) caracteriza-se por edema orofacial, paralisia facial recorrente e língua plicada. A tríade completa é incomum, com freqüência variando de 8 a 25 por cento, sendo que a apresentação mais comum é a presença de somente um sintoma. A queixa mais freqüente é o edema facial e/ou no lábio. No presente relato, descreve-se o caso de uma jovem, 17 anos, com edema no lábio persistente e língua plicada devido à SMR. A paciente informou que o edema e as alterações na língua haviam se iniciado há 2 anos. Tratamentos prévios haviam sido realizados, porém sem sucesso. Propôs-se a injeção intralesional de 20mg de triancinolona a cada 15 dias, associada a 5mg ao dia de clofazimine por três meses. O lábio voltou ao seu aspecto normal após quatro infiltrações da medicação. Estudos recentes têm considerado a SMR como uma doença granulomatosa, sendo a fase inicial da apresentação orofacial da Doença de Crohn em alguns pacientes. Assim, pacientes com SMR deveriam ser avaliados e seguidos quanto à presença de sintomas gastroenterológicos. O tratamento com corticosteróides tem se mostrado efetivo em reduzir a tumefação do lábio associada a essa doença. Discute-se características clínicas, tratamento e importância da terapia com corticosteróides na paralisia facial associada à SMR.

Melkersson-Rosenthal syndrome (MRS) consists of persistent or recurrent orofacial edema, relapsing facial palsy and fissured tongue. The complete triad of symptoms is uncommon, varying from 8 to 25 percent. The presentation of only one symptom is more common. The most frequent complaint is facial edema and enlargement of the lips. We describe a case of a 17-year-old Brazilian girl with limited edema of the lower lip and fissured tongue due to MRS. Her complaints had started two years before. She referred previous clinical treatments without success. We proposed intralesional injection of triamcinolone at 20 mg every 15 days associated with oral clofazimine at 50 mg/day for three months. The lip became normal after four triamcinolone injections. Recent studies have considered MRS a granulomatous disease, and possibly the initial presentation of CrohnÆs disease in orofacial area of some patients. MRS patients, therefore, should be screened and monitored for gastrointestinal symptoms. Corticosteroid treatment seems to be effective in reducing lip enlargement. We discus the clinical features of this disease, the treatment, and the importance of corticosteroid therapy in cases of MRS-related facial palsy.

Crohn's Disease Associated with IgA Nephropathy / 대한소화기학회지

Crohn's disease is a condition of chronic inflammation potentially involving any location of the alimentary tract from mouth to anus. Numerous extraintestinal manifestations can also be present. Urologic complications of inflammatory bowel disease are seen in up to 25% of patients, but renal parenchymal disease has been rarely reported. IgA nephropathy is recognized worldwide as a most common form of primary glomerulonephritis. Clinical manifestations vary, ranging from microscopic hematuria to nephrotic syndrome. Recently, IgA nephropathy associated with systemic diseases has been reported. We describe a case of a 22 year-old man with Crohn's disease associated with IgA nephropathy. At the age of 8 years, microscopic hematuria appeared. After fourteen years, he presented with melena, mild fever, recurrent oral ulcer, microscopic hematuria and proteinuria. Colonoscopic examination revealed characteristic features of Crohn's disease such as multiple ulcers. Microscopic findings showed superficial ulceration with small noncaseating granulomas. Renal biopsy revealed IgA nephropathy. The patient was treated with oral prednisolone, olsalazine, and metronidazole followed by maintenance therapy with sulfasalazine and azathioprine resulting in clinical improvement of Crohn's disease and IgA nephropathy.

Diagnosis and Treatment of Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) comprises a group of idiopathic diseases of the intestine characterized by chronic inflammation of the bowel with periods of exacerbation and remission. The two major categories of IBD are ulcerative colitis and Crohn's disease, and each disease is distinct both clinically and histologically. The exact cause of IBD remains unknown, but several theories have been proposed. Primary care physicians are frequently confronted with the initial diagnosis and management of patients with IBD, and medical treatment options have rapidly expanded in recent years. This article reviews clinical presentations that are essential to establish a diagnosis in this complex disease and the treatment options available.

A case of Crohn's disease of the vulva / 대한피부과학회지

Crohns disease is a granulomatous isease of the gastrointetin 1 tract, especially terminal ileum, but may involve the lip, mouth, anus, skin, liver and bone. The skin is a common site of extraintestinal involvement in Crohns disease, with the perianil, perineal, and peristomal areas most frequently affected. Vulvar involvement, however, is an uncommon extraintestinal manifestantion of Crohns disease. We report a case of a 16-year-old girl with Crohns disease of the vulva and perianal region. A histopathologic study of the descending colon and vulvar skin showed noncaseating granulomatous reactions composed of lymphocytes, epithelioidell and giant cells. We were able to make the diagnosis of Crohns disease of the vulvar and the patient was treated with prednisolone and metronidazole.