Crohn’s Disease of the Vulva

Abstract

Three patients with Crohn's disease primarily involving the large intestine had unusual abscesses of the vulvar area. At biopsy, the abscesses had classic features of the primary disease and were clearly separated from the intestinal tract. There was no fistula in the anal canal, and the perineum between the vulvar abscess and the anus was normal. One of the patients also had an early lesion of Crohn's disease in the sigmoid. The lesion appeared as a small erythematous spot without ulceration. Biopsy revealed a typical granuloma under an intact mucosa. It is concluded that Crohn's disease is not confined to the gastrointestinal tract, and that early lesions of the disease within the gastrointestinal tract are submucosal rather than mucosal.

Abces Clitoridien Spontane: A Propos D Un Cas

“…Étant une pathologie rare ; les publications enregistrées sur les abcès clitoridiens spontanés ne sont pas des séries de cas mais seulement des cas rapportés. 19 cas d'abcès péri clitoridiens spontanés sont rapportés dans la littérature médicale anglaise [3,4,5,6,7,8,9,10,11,12,13,14,15,16].L'étiologie du développement spontané de ces abcès n'est pas claire dans la plupart des cas. Le mécanisme pathogénique pourrait être un défaut de l'épithélium stratifié squameux qui permet l'entrée d'agents pathogènes.En effet, plusieurs microorganismes à l'origine de la collection abcédées des infections ont été isolées dans certains des cas publiés:coagulase positiveStaphylococcus, Streptococcus bovis, Diptheriaespecies et Bacteroides species [3,4,16].…”

“…Le mécanisme pathogénique pourrait être un défaut de l'épithélium stratifié squameux qui permet l'entrée d'agents pathogènes.En effet, plusieurs microorganismes à l'origine de la collection abcédées des infections ont été isolées dans certains des cas publiés:coagulase positiveStaphylococcus, Streptococcus bovis, Diptheriaespecies et Bacteroides species [3,4,16]. Dans un autre cas, un abcès périclitoridien a été formé dans le cadre de tissu mammaire ectopique, un cas d'abcès périclitoridien a été rapporté chezune patiente atteinte de la maladie de Crohn [5,6]. Dans un groupe distinct de patientes ; il a été démontré que le développement de l'abcès péri-clitoridien est une complication du sinus pilonidal existant du clitoris [7,12].…”

Granulomatous Vaginal Ulceration due to Metastatic Cutaneous Crohn′s Disease

“…In the extraintestinal tract manifestations of Crohn's disease, involvement of the skin is common; indeed, 20 to 40% of Crohn's disease patients may have dermatological features. MCCD, however, is rare, with fewer than 30 reported cases in the literature (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(15)(16)(17)(18)(19)(20). The lesion of MCCD may manifest as an ulcer, nodule or plaque and has been identified principally in the retroauricular region and inframammary area, as well as the face, upper and lower extremities, umbilicus, lower abdominal wall, penis and vulva.…”

“…Treatment of MCCD, however, still needs more critical evaluation. Numerous modalities have been employed, including topical zinc and/or systemic steroids (3,7,15,17), oral and intravenous antibiotics, particularly metronidazole (7,8,(15)(16)(17)(18) and immunosuppressive agents, including 6mercaptopurine (8), and surgical excision (3,16). Occasionally (3), symptomatic measures alone have been associated with complete healing of MCCD.…”

“…In addition, direct enteric fistulous communication with the genitourinary tract may occur. Fi-nally, vaginal or other cutaneous lesions (ie, erosions, ulcers) separated from the gastrointestinal tract by normal skin (ie, 'skip lesions') have very rarely been reported in Crohn's disease; in the case of genital disease, these are generally characterized by the absence of perineal and/or perianal disease and histologically by the presence of giant cells, noncaseating granulomas or both (4)(5)(6)(7)(8). This phenomenon, called 'metastatic' cutaneous Crohn's disease (MCCD) (9-13), appears to have a variable clinical course, but requires careful differentiation from other, especially infectious, causes.…”