Rare Mouth Ulcer Might Indicate Crohn’s Disease

Rare Mouth Ulcer Might Indicate Crohn’s Disease

shutterstock_61876537In a recent study entitled “Buccal localization of Crohn’s disease with long-term infliximab therapy: a case report,” the authors highlight the need to recognize Cheilitis granulomatosa lesions in the mouth as a marker for possible Crohn’s disease. The study was published in the Journal of Medical Case Reports.

Cheilitis granulomatosa (CG) is characterized by a chronic swelling of the lip and ulceration due to granulomatous inflammation. It is usually associated with a manifestation of Melkersson-Rosenthal syndrome (a rare neurological disorder characterized by facial paralysis, together with swelling of the face and lips), however, despite being considered a rare event, it can also be a unique early manifestation of Crohn’s disease (one of the common types of Inflammatory Bowel Disease, characterized by inflammation of the intestinal tract, that may include the whole tract, from mouth to anus).

Here, the authors describe a 23-year old-Caucasian man’s case, diagnosed with Cheilitis granulomatosa in his lower lip in a first approach and treated solely according to this diagnosis. The treatment consisted of antibiotics and steroids, however, it yielded no improvement in the patient’s lower lip. Two years later, the patient was submitted to a lower lip biopsy and the cheilitis granulomatosa diagnosis was confirmed. However, the patient complained of pain during defecation, a symptom already registered in its first clinical visit, and he was actually treated then for anal fissure but since then reported a moderate discomfort with evacuation. With confirmed diagnosis for Cheilitis granulomatosa, however, the anal disease was underestimated. Upon the patients’ report of anal disease, the clinician’s prescribed further exams Crohn’s disease was confirmed. With the new diagnosis, the patient was submitted to infliximab, which successfully treated all Crohn’s disease manifestations.

With this case-report, the authors highlight that gastroenterologists as well as dentists and dermatologists should recognize Cheilitis granulomatosa as a manifestation of another underlying disease such as Crohn’s disease, but also other immune-mediated diseases such as arthritis, and proceed with full examinations to prescribe the best suitable and more efficient treatment.

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