Nasal Septal Perforation: A Rare Extraintestinal Manifestation of Crohn's Disease

Abstract

Nasal manifestations of Crohn 's disease are quite rare. They are typified by chronic mucosal inflammation, obstruction, bleeding, and occasionally septalpelf orationsigns and sympto ms that are common to many disease states ofthe nose. Nasal finding s, much like oral lesions , can precede the more typical gastroenterologic manifestations of Crohn 's disease. Otolaryngologists should be aware ofsuch an association and consider the diagnosis of Crohn 's disease in atypical cases of nasal disease. We repo rt the case of a 12-year-old boy who had severe Crohn 's disease and a nasal septal pelf oration, and we discuss thi s comp lication in the contex t of its otolaryngologic manifestations.

Nasal Septal Perforation in an Adolescent Girl with Crohn’s Disease: A Rare Extraintestinal Manifestation

“…In the literature, histologic findings of nasal CD were reported as chronic inflammatory changes similar to our case [3,8]. Authors demonstrated that in CD nasal histologic findings are similar to oral lesions where granulomas are detected in only 10-68% of specimens [11].…”

“…2 Endoscopic nasal examination showed posterior nasal septal perforation approximately 2 cm in diameter mercaptopurine. He complained of nasal crusting, mild congestion, and epistaxis [3]. Our patient also had nasal septal perforation and severe gastrointestinal involvement requiring intensive immune suppressive therapy.…”

“…Pochon et al [8] and Ulnick et al [9] described nasal obstruction in two adults. A fifth case, the only one involving a nasal perforation, was a 12-year-old boy reported by Kriskowich et al [3]. This patient had severe granulomatous colitis.…”

“…Although an asymptomatic perforation rarely requires any treatment, topical nasal steroids, moisturizers, and antibacterial ointments are recommended in the literature for nasal CD [10]. When the extraintestinal lesions fail to respond to this therapy, systemic steroids become the mainstay of therapy [3,10,12]. Recently, infliximab (anti-TNF-α antibody) has shown a strong beneficial effect, especially in fistulous CD refractory to conventional therapy [13].…”

“…Joints, skin, eye, anus, and liver are the most commonly affected organs [1]. However, it is unusual for the disease to manifest in the upper aerodigestive system [2,3]. In this article we describe a case of an adolescent girl with severe CD that was marked with involvement of the nasal septum.…”