Vulvoperineal Crohn's disease responsive to metronidazole

Abstract

Crohn's disease is a multisystem chronic granulomatous inflammatory disease that primarily affects the gastrointestinal tract. In the majority of the cases, the cutaneous manifestations follow the intestinal disease, but occasionally dermatological lesions are the inaugural event and may constitute the only sign of the disease. Vulvoperineal involvement is rare, may precede bowel symptoms by months to years and may go unrecognized. Due to the paucity of reports of Crohn's disease at this location and in the absence of randomized trials, there are no standard treatments for the cutaneous disease. We describe the case of a 47 year-old woman with vulvoperineal Crohn's disease without digestive involvement, that was successfully managed with metronidazole.

Crohn's disease of the vulva: A tough diagnosis (a case report of a 47 y.o. patient)

“…Epidemiological data on the prevalence of CD of the vulva are currently scarce, which is probably due to misdiagnosis. In some cases, it took patients 5 years to be diagnosed with CD of the vulva . To date, to the best of our knowledge, 146 cases of isolated CD of the vulva have been described worldwide .…”

“…In some cases, it took patients 5 years to be diagnosed with CD of the vulva. 4 To date, to the best of our knowledge, 146 cases of isolated CD of the vulva have been described worldwide. 5 Thus, reports on each confirmed case of CD of the vulva contributes to the accumulation of international knowledge and experience in the field and, which can significantly shorten the time between manifestation of the first symptoms and the correct diagnosis.…”

Cutaneous Crohn's disease successfully treated with adalimumab

“…1,2 Although the most common symptoms of DRA are shoulder pain and carpal tunnel syndrome, 3 skin involvement can occur and disease control is difficult. 4,5 Here, we report a case of extensive subcutaneous masses on the buttocks caused by long-term haemodylasis, which led to the death of the patient. A 64-year-old man presented with a several year history of induration of the buttocks.…”

“…Oral methylprednisolone (16 mg/day) for 2 months was ineffective. Subsequently, metronidazole (1 g/day) was started, due to its anti-inflammatory, antibacterial and immunosuppressive action, 4 with mild improvement of the skin lesions but this therapy was stopped 1 month later because of severe stomach ache. On the basis of the well-known good efficacy of anti-TNFa therapy in Crohn's diseases, 5 we finally started adalimumab (160 mg at time 0; 80 mg after 2 weeks; 40 mg EOW).…”