Oral manifestations as the first presenting sign of Crohn's disease in a pediatric patient

Abstract

Crohn’s disease (CD) is a chronic inflammatory disorder affecting the gastrointestinal (GI) tract. Although the GI tract is the primary site of involvement, many patients, particularly in pediatric cases, first present with non-intestinal manifestations, including oral lesions. Oral manifestations of CD in children occur in around 50-80% of cases, and about 30% of CD cases in children occur first in the mouth. Recognizing such oral lesions in the pediatric population, and requesting a biopsy, may expedite the diagnosis of CD. We describe a 15 year old male who presented with oral findings of multiple aphthous ulcers and plaques of pink papules of the buccal vestibule. We highlight the initial pathology findings, including non-caseating granulomas, sialadenitis, and a notable plasmacytosis, from biopsy of the left retromolar pad area, which triggered further testing for CD. We provide discussion of how CD was eventually diagnosed and treated and highlight the significance of the pathological findings in this case as they relate to the pathogenesis of CD. Key words:Crohn’s disease, Inflammatory bowel disease, Oral manifestations, Pediatric, Granulomatous inflammation, Monotypic plasma cells.

Th17 Cells and the IL-23/IL-17 Axis in the Pathogenesis of Periodontitis and Immune-Mediated Inflammatory Diseases

“…Oral manifestations and implications of inflammatory bowel diseases are reported in a varying range from 0,5% to 37% among diseased individuals; they may appear as the first signs of the disease, especially in children, and include edema, mucogingivitis, oral ulcers, and hyperplastic lesions among others [139,140,141]. Involvement of upper regions of gastrointestinal tract and extra-gastrointestinal symptoms predict a more severe phenotype of the disease and may present with comorbidities due to the increased risk of systemic involvement [142].…”

A rare case of pediatric Crohn’s disease and alveolar bone loss: a report and review

“…Investigations have discovered that CD adults often have soft tissue problems in the oral cavity, which can include Figure 6 Periapical film revealed that the alveolar bone had remained stable one year after comprehensive treatment oral ulcerations, cobblestone mucosa, and granulomatous cheilitis (5)(6)(7). These patients may also experience concurrent periodontal involvements, including higher tendency of bleeding on probing, deeper periodontal pocketing, and significant alveolar bone loss when compared to the general population (8)(9)(10)(11). The hazard ratio for subsequent periodontitis among patients with CD was found to be 1.36 compared to healthy subjects (11).…”

“…The prevalence of oral manifestations in IBD has been reported to range widely from 7.3% to 41% in children (3,12). Most oral manifestations are mucocutaneous findings (3,8), and oral mucosal lesions can be specific or nonspecific. Among the specific lesions correlated to CD, are mucosal tags, cobblestone mucosa, and labial swelling linked to granulomatous cheilitis.…”

Oral and Maxillo-Facial Manifestations of Systemic Diseases: An Overview

“…Overall, oral lesions may be variably identified in up to 60% of patients, while in 5–10% of cases they represent the first manifestation of a still unknown CD [ 101 , 102 , 118 ]. The oral manifestations of CD are also uncommon in children and can precede or coincide with intestinal inflammatory lesions, leading frequently to a delayed diagnosis [ 119 , 120 , 121 ].…”