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

Triantafillidis JK, Valvi FZ, Merikas E, Peros G, Galitis ON, Gikas A - J Med Case Rep (2008)

Bottom Line: 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.Conservative treatment resulted in clinical and laboratory improvement of the bowel symptoms and lip swelling.Exacerbation of the lip lesion could be an early clinical sign of a relapse of the underlying intestinal disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gastroenterology, "Saint Panteleimon" General Hospital, Nikea, Greece. jkt@vodafone.net.gr

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.

No MeSH data available.


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Lip swelling before the appearance of bowel symptoms (June 1996).
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Figure 1: Lip swelling before the appearance of bowel symptoms (June 1996).

Mentions: The patient was a man aged 25. He was a smoker (20 cigarettes per day) since the age of 19. His symptoms started on June 1998 at the age of 24, with chronic diarrhea not accompanied by mucus or blood in the stools, abdominal pain, fever, or loss of weight. Two years previously on June 1996, he had noticed a slight swelling of the lower lip which contrasted with the previously normal appearance of his mouth (Figure 1). He consulted a specialist in oral medicine, who performed a lip biopsy. The histology of the specimen (13 × 7 × 7 mm) showed a multilayer squamous epithelium covering the tissue specimen, scattered clusters of lymphocytes and histiocytes resembling non-caseating granulomas, as well as infiltration of the small vessel walls of the underlying connective tissue by monocytes (Figure 2). The diagnosis was compatible with granulomatous cheilitis. Colonoscopy performed in 1998 revealed large ulcers in the terminal ileum and caecum. Enteroclysis confirmed the involvement of the terminal ileum in a total length of 50 cm. Administration of methylprednisolone, mesalazine and cholestyramine, resulted in prompt improvement of clinical symptoms and laboratory abnormalities.


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

Triantafillidis JK, Valvi FZ, Merikas E, Peros G, Galitis ON, Gikas A - J Med Case Rep (2008)

Lip swelling before the appearance of bowel symptoms (June 1996).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2267202&req=5

Figure 1: Lip swelling before the appearance of bowel symptoms (June 1996).
Mentions: The patient was a man aged 25. He was a smoker (20 cigarettes per day) since the age of 19. His symptoms started on June 1998 at the age of 24, with chronic diarrhea not accompanied by mucus or blood in the stools, abdominal pain, fever, or loss of weight. Two years previously on June 1996, he had noticed a slight swelling of the lower lip which contrasted with the previously normal appearance of his mouth (Figure 1). He consulted a specialist in oral medicine, who performed a lip biopsy. The histology of the specimen (13 × 7 × 7 mm) showed a multilayer squamous epithelium covering the tissue specimen, scattered clusters of lymphocytes and histiocytes resembling non-caseating granulomas, as well as infiltration of the small vessel walls of the underlying connective tissue by monocytes (Figure 2). The diagnosis was compatible with granulomatous cheilitis. Colonoscopy performed in 1998 revealed large ulcers in the terminal ileum and caecum. Enteroclysis confirmed the involvement of the terminal ileum in a total length of 50 cm. Administration of methylprednisolone, mesalazine and cholestyramine, resulted in prompt improvement of clinical symptoms and laboratory abnormalities.

Bottom Line: 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.Conservative treatment resulted in clinical and laboratory improvement of the bowel symptoms and lip swelling.Exacerbation of the lip lesion could be an early clinical sign of a relapse of the underlying intestinal disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gastroenterology, "Saint Panteleimon" General Hospital, Nikea, Greece. jkt@vodafone.net.gr

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.

No MeSH data available.


Related in: MedlinePlus