A case of Crohn’s disease presenting mainly oral symptoms

Abstract

Crohn’s disease (CD) is a granulomatous inflammatory disorder with no known cause. CD is categorized as an inflammatory bowel disease, with the main symptom being colitis. Recognised oral symptoms include aphthous stomatitis and granulomatous cheilitis. We describe a case of CD in a 14-year-old boy who presented with swollen lips. Our examination revealed that he had no abdominal symptoms, but he had additional oral symptoms such as gingivitis, mucosal tag, an ulcer and cobblestone appearance mucosa. Eosinophilic granuloma and gingivitis were suspected. Administration of an anti-allergic drug and periodontal treatment were commenced; however, his symptoms didn’t change. We obtained information that he had had hemorrhoids in the past, indicating a diagnosis of CD. An upper gastrointestinal endoscopy and colonoscopy were performed, and aphthous and ulcerative lesions were found at the rectum and a biopsy was done. Epithelioid cell granuloma (ECG) was detected from the specimen and a final diagnosis of CD was made. The swollen gingiva didn’t respond to treatment. It was excised and ECG was also detected in it. He was given mesalazin and prednisolone, but the oral symptoms remained unchanged and fecal occult blood test (FOBT) remained positive. Adding adalimumab to his medication improved the oral symptoms and the FOBT became negative.