Granulomatous Cheilitis Preceding Gastrointestinal Manifestations of Crohn's Disease

Abstract

We describe a 20-year-old male with no significant medical history who presented with a 1-month history of painless upper and lower lip edema initially treated with antibiotics for suspected cellulitis before arriving to the clinic. After a failed response to that treatment, a lip biopsy was eventually performed and consistent with a diagnosis of granulomatous cheilitis. In addition to oral and topical corticosteroids and tacrolimus, the patient adopted the cinnamon-and benzoate-free diet with some improvement of his lip swelling. Persistent mild tachycardia led to a cardiology referral for further evaluation and sarcoidosis workup. A gastroenterology consult was placed to correlate his presentation with Crohn's disease. The cardiology workup was noncontributory, and the patient was ultimately diagnosed with Crohn's disease after evaluation with laboratory studies and colonoscopy. This case highlights the need to evaluate for Crohn's disease in patients who present with granulomatous cheilitis, even in the absence of gastrointestinal symptoms, and the potential benefit of incorporating a cinnamon-and benzoate-free diet in treatment.

Upadacitinib for Treatment of Granulomatous Cheilitis

“…Despite various hypotheses, including factors such as food allergy, genetics, infection, and atopy, its exact cause remains unknown. Granulomatous cheilitis is an exclusion diagnosis, and most cases remain isolated; however, it can be associated with systemic diseases such as Crohn disease (CD), sarcoidosis, or Melkersson-Rosenthal syndrome. Current treatment primarily involves topical or intralesional corticosteroids, with severe cases often requiring systemic agents such as biologics, with variable outcomes and frequent relapses.…”