Images in Clinical Medicine
Oral Manifestations of Crohn's Disease
N Engl J Med 2000; 342:1644June 1, 2000
- Article
Figure 1 An eight-year-old girl had a four-month history of painful mouth lesions, resulting in decreased oral intake and weight loss, and a one-year history of intermittent abdominal pain and irregular bowel movements. On examination, she had cheilitis, redness and swelling of the gingiva, and oral ulcerations (Panels A and B), as well as tenderness of the right lower quadrant and a perianal fissure. Colonoscopy with multiple biopsies revealed findings consistent with the presence of Crohn's disease. Five weeks after the initiation of treatment with 40 mg of oral prednisone daily (2 mg per kilogram of body weight), the patient's cheilitis had greatly improved (Panel C), as had the gastrointestinal symptoms. The gastrointestinal disease relapsed when prednisone therapy was tapered and then stopped. During the following 3 1/2 years the patient continued to have active disease despite treatment with prednisone and azathioprine, but the lip and oral lesions did not recur. Intestinal obstruction and peritonitis developed and required resection of the ileocecal region and anastomosis of the ileum to the ascending colon. The doses of prednisone and azathioprine were reduced gradually, and at the most recent follow-up visit, the patient was in remission while taking 25 mg of azathioprine three times daily.
Tamar Stricker, M.D.
Christian P. Braegger, M.D.
University Children's Hospital, CH-8032 Zurich, Switzerland- Citing Articles (3)
Citing Articles
1
Marion Rowland, Paddy Fleming, Billy Bourke. (2009) Looking in the mouth for Crohn's disease. Inflammatory Bowel DiseasesNA-NA
CrossRef2
H.J. Scheper, H.S. Brand. (2002) Oral aspects of Crohn's disease. International Dental Journal 52:3, 163-172
CrossRef3
Darwin Deen. (2001) Nutritional Assessment of the Oral Cavity. Nutrition in Clinical Care 4:1, 28-33
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