Granulomatous Cheilitis and Crohn's Disease

Ahmad, Ishfaq; Owens, David E.

doi:10.1155/2001/602183

Cited by 14 publications

(12 citation statements)

References 12 publications

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“…The oral cavity can be subjected to direct visual examination and biopsy. We10, 13 and others14, 16, 25–27 have shown a very high rate of granuloma detection in oral biopsies. Plauth et al16 report granulomas present in up to 77% of oral biopsies.…”

Section: Diagnostic Utility Of Oral Biopsymentioning

confidence: 85%

Looking in the mouth for Crohnʼs disease

Rowland¹,

Fleming

Bourke

2010

Inflammatory Bowel Diseases

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It is widely acknowledged among gastroenterologists that the oral cavity may be involved in Crohn's disease (CD). However, the specific manifestations are poorly appreciated. Although oral aphthous ulceration is probably not diagnostically useful in patients with suspected CD, disease-specific manifestations do occur and are particularly common in children presenting with CD. These manifestations can be subtle, often are subclinical, yet commonly harbor diagnostically useful material (granulomas). Orofacial granulomatosis (OFG) is conventionally used to describe patients with overt oral disease without obvious involvement of the gastrointestinal tract. However, many patients with OFG have subclinical intestinal CD or will progress to develop overt intestinal CD with time. The management of severe oral disease is challenging and lacks a clear evidence base.

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Section: Diagnostic Utility Of Oral Biopsymentioning

confidence: 85%

Looking in the mouth for Crohnʼs disease

Rowland¹,

Fleming

Bourke

2010

Inflammatory Bowel Diseases

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“…Eine granulomatöse Entzündung der Lippen mit deutlicher teigiger Schwellung, eine sog. Cheilitis granulomatosa (orofaziale Granulomatose, Melkersson-Rosenthal-Syndrom), kann ebenfalls bisweilen die Erstmanifestation eines Morbus Crohn sein und sollte in jedem Fall entsprechende Untersuchungen nach sich ziehen [3,33,54,165]. Aus dem eigenen Patientengut können wir über zwei Patienten berichten, bei denen eine Koloskopie bei Cheilitis granulomatosa die Diagnose eines Morbus Crohn erbrachte, obwohl intestinale Symptome nicht im Vordergrund standen [54].…”

Section: Hautunclassified

Extraintestinale Manifestationen bei chronischentz�ndlichen Darmerkrankungen*

Rogler

Schölmerich²

2004

coloproctology

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ZusammenfassungExtraintestinale Manifestationen von Morbus Crohn und Colitis ulcerosa finden sich bei mehr als der Hälfte aller Patienten und können belastender als die Grunderkrankung selbst sein. Extraintestinale Manifestationen müssen von Sekundärerkrankungen oder Folgen der chronisch-entzündlichen Darmerkrankungen (CED) unterschieden werden, da sie einer anderen Therapie bedürfen. Während Krankheitsfolgen wie Vitaminmangelzustände oder Osteoporose durch Vitaminsubstitution oder Calciumund Vitamin-D-Gabe spezifisch therapierbar sind, ist die Therapie extraintestinaler Manifestationen von CED wie der primär sklerosierenden Cholangitis, der sog. Typ-II-Arthritis oder granulomatöser Entzündungen der Haut, Leber oder Lunge häufig deutlich schwieriger und komplexer. Extraintestinale Symptome des Morbus Crohn und der Colitis ulcerosa können sich an nahezu jedem Organ manifestieren. Es ist wichtig, diese extraintestinalen Manifestationen der CED zu kennen, um einerseits rechtzeitig und frühzeitig Therapiemaßnahmen einleiten zu können.Andererseits können extraintestinale Symptome die Primärmanifestation eines Morbus Crohn und seltener einer Colitis ulcerosa darstellen. Sie müssen dann als solche erkannt werden, um die Betroffenen frühzeitig adäquat therapieren zu können. Schlüsselwörter: Chronisch-entzündliche Darmerkrankungen · Morbus Crohn · Colitis ulcerosa · Extraintestinale Manifestationen SummaryExtraintestinal manifestations of Crohn's disease and ulcerative colitis are found in > 50% of all patients.These extraintestinal manifestations sometimes impair the overall life quality much more than the bowel-related symptoms. Extraintestinal manifestations need to be distinguished from secondary diseases or complications of inflam-coloproctology coloproctology 2004;26:152-62

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“…It is of interest that, like other extraintestinal manifestations, oral lesions may precede the onset of the underlying intestinal inflammatory disorder [ 3 , 7 , 8 ]. However, it is difficult to determine exactly which oral manifestation is certainly related to CD although it is logical to hypothesize that some of these lesions are in fact consequence of the disease or a secondary reaction to medical treatment.…”

Section: Introductionmentioning

confidence: 99%

Granulomatous cheilitis associated with exacerbations of Crohn's disease: a case report

et al. 2008

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Abstract

Introduction

Crohn's disease is a disease involving the whole gastrointestinal tract from the mouth to the anus. Oral lesions are considered to be an important extraintestinal manifestation. Granulomatous cheilitis has been recognized as an early manifestation of Crohn's disease. It may follow, coincide with or precede the onset of Crohn's disease. The aim of this presentation is to describe a rare case of a patient with Crohn's disease in whom significant swelling of the lower lip not only preceded the diagnosis of Crohn's disease for two years, but it manifested as an early clinical index of the recurrence of the intestinal disease as well.

Case presentation

A man aged 25 was admitted in our department on August 1999 with chronic diarrhea and loss of weight. His bowel symptoms started in 1998 at the age of 24. However, two years previously (June 1996) he noticed a swelling of the lower lip, which contrasted significantly with the previously normal appearance of his mouth. A lip biopsy performed at that time was compatible with granulomatous cheilitis. Crohn's disease involving the terminal ileum and large bowel was diagnosed in 1998 and confirmed on the basis of colonoscopy, enteroclysis and histology findings of the small and large bowel. Conservative treatment resulted in clinical and laboratory improvement of the bowel symptoms and lip swelling. During the following years the disease was active with exacerbations and remissions of mild to moderate severity. The swelling of the lower lip occurred in parallel with the exacerbations of the bowel disease, returning to normal during periods of remission.

Conclusion

Significant swelling of the lower lip due to granulomatous cheilitis could be the first manifestation of Crohn's disease, preceding intestinal symptoms. Exacerbation of the lip lesion could be an early clinical sign of a relapse of the underlying intestinal disease.

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Granulomatous Cheilitis and Crohn's Disease

Cited by 14 publications

References 12 publications

Looking in the mouth for Crohnʼs disease

Looking in the mouth for Crohnʼs disease

Extraintestinale Manifestationen bei chronischentz�ndlichen Darmerkrankungen*

Granulomatous cheilitis associated with exacerbations of Crohn's disease: a case report

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