Vulval oedema: how many doctors does it take to make a diagnosis?

Mitchell, L.; Hussey, Jane; Mansfield, J C; Gunn, M; McLelland, Janet; Needham, Shirley F.

doi:10.1016/j.ejogrb.2013.10.020

Cited by 2 publications

(5 citation statements)

References 5 publications

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“…It was shown that peripheral monocytes from patients with CD have higher basal production of TNF‐α regardless of NOD2 genotype and without a clear correlation with disease activity 36 . There are also reported cases of granulomatous vulvitis with occasional lymphangiectasia secondary to CD 37‐39 . In this case, emphasis should be given to the cooccurrence of the ectatic lymphatic vessels and granulomatous inflammation that is notably associated with CD.…”

Section: Discussionmentioning

confidence: 85%

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Oral lymphangiectasia and gastrointestinal Crohn disease

et al. 2020

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Lip edema with non-caseating granulomas or lymphangiectasia pose a clinical and pathological challenge. These findings can be attributed to cheilitis granulomatosa (CG), Melkersson-Rosenthal syndrome (MRS), or Crohn disease (CD) depending on the appropriate clinical context. Lymphangiectasis, in particular, is a common pathological finding in CD due to lymphatic obstruction by granulomas and intralymphatic granulomas. Because oral symptoms can precede gastrointestinal symptoms of CD or be seen in patients with asymptomatic gastrointestinal disease, the identification of lymphangiectasia should raise the possibility of underlying CD. We present a case of a young woman with several years of lip swelling, with notable lymphangiectasia and subtle granulomas on pathological evaluation. The patient was diagnosed with MRS at an outside institution and treated with systemic steroids, without further systemic evaluation. We believe that early recognition of lymphangiectasia and consideration of CD early in the work-up are critical for early diagnosis and appropriate management. Neither clinical nor histopathological findings should be used in isolation to diagnose GC, MRS, or CD as there is significant debate as to the etiology and overlapping findings of these conditions.

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Section: Discussionmentioning

confidence: 85%

“…36 There are also reported cases of granulomatous vulvitis with occasional lymphangiectasia secondary to CD. [37][38][39] In this case, emphasis should be given to the cooccurrence of the ectatic lymphatic vessels and granulomatous inflammation that is notably associated with CD.…”

Section: Discussionmentioning

confidence: 99%

Oral lymphangiectasia and gastrointestinal Crohn disease

et al. 2020

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“…8,9 Vulvar swelling has been described as a symptom that can involve a high number of consulting services such as primary care, gynecology, urology, dermatology, and gastroenterology. 5 Although multiple case reports have been published on this topic since 1970, the diagnosis of CD is still often missed. Particularly striking was the number of cases where child abuse was suspected.…”

Section: Discussionmentioning

confidence: 99%

“…1 In addition, cases exist in the literature of patients suffering from sporadic gastrointestinal symptoms for prolonged periods of time before diagnosis of the underlying inflammatory bowel disease is made. 5 In increasingly burdened healthcare systems, diagnosing inflammatory bowel diseases when the patient is younger also results in significant cost savings and decreased resource utilization. 12 Another takeaway, we would like to reinforce is the concept that there can be a delay in the response of vulvar symptoms to systemic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 When this occurs, pediatricians and sub-specialists are often faced with diagnostic dilemmas and patients consequently suffer from prolonged symptoms and extraneous treatments. 5 In this article, we report the case of a pediatric patient who presented to dermatology for vulvar swelling and was ultimately diagnosed with metastatic CD. We also provide a brief review of the literature on similar cases and discuss the importance of maintaining a high index of suspicion for this presentation.…”

Section: Introductionmentioning

confidence: 99%

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Vulvar swelling and the timely diagnosis of Crohn’s disease: A case report

Gomolin

Zargham

Sant’Anna

et al. 2021

SAGE Open Medical Case Reports

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Children with vulvar swelling often present to multiple physicians and face a prolonged period of ambiguity and extraneous treatments. Here, we report a case of an 8-year-old girl who presented to the dermatology clinic with a 2-month history of vulvar swelling and was ultimately diagnosed with Crohn’s disease. Although extra-intestinal manifestations are common in inflammatory bowel diseases, they rarely present before an existing diagnosis. This report highlights this potential early manifestation and demonstrates how timely diagnosis leads to improved outcomes for patients, their families, and healthcare systems.

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Vulval oedema: how many doctors does it take to make a diagnosis?

Cited by 2 publications

References 5 publications

Oral lymphangiectasia and gastrointestinal Crohn disease

Oral lymphangiectasia and gastrointestinal Crohn disease

Vulvar swelling and the timely diagnosis of Crohn’s disease: A case report

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