Vulvar Chron`s disease is a challenge: Case report

Introduction Crohn´s disease (CD) may involve all parts of the gastrointestinal tract. Extra-intestinal manifestations with or without continuity to the intestine are described. The most common complications are the involvement of the bones (articulations), liver and eyes.

To confirm the diagnosis of an extra-intestinal Crohn´s disease of the vulva is difficult due to the great variety of signs and symptoms.

Case Our case report on a 25-year-old woman who has a history of a marked chronic-inflammatory bowel disease of the lower recto-sigmoid area. She reported burning and painful sensation of the vulva that was unsuccessfully treated with various ointments before the Crohn´s disease was confirmed. On examination the labia minora and the mons pubis area were covered with erosive lesions (knife-like) and undefined scarring. In addition, a biopsy was performed revealing a non-caseating granulomatous lesion. The histo-pathological findings are in line with an extra-intestinal manifestation of the Crohn´s disease.

The symptoms responded temporarily with the initiated treatment with local Clobetasol.

The following various clinical vulvar manifestation of Crohn´s disease are described by Barret et al.: Vulvar swelling or edema, Ulceration, Hypertrophic lesions and Chronic suppuration leading to abscess formation.

Differential diagnosis include sarcoidosis, tuberculosis, lymphogranuloma venereum, hidradenitis suppurativa, intertrigo and syphilitic lesions. Definitive diagnosis can only be achieved by biopsy which would reveal a non-caseating granulomatous lesion.

Conclusion Vulvar Crohn´s disease is a diagnostic and therapeutical challenge.Metronidazole with or without Prednisolone, seems to be the most effective treatment option with reported success rates up to 87,5 % with low adverse effects.

Publication History

Article published online:
07 October 2020