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Crohn’s disease initiated with extraintestinal features
  1. Jeffrey Chang1,2,
  2. Chia-Cheng Li3,
  3. Marina Achtari4 and
  4. Eleana Stoufi5,6
  1. 1 Department of Gastroenterology, Nutrition and Hepatology, Boston Childrens Hospital, Boston, Massachusetts, USA
  2. 2 Department of Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
  3. 3 Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
  4. 4 Department of General and Special Care Dentistry, Penteli Children’s Hospital, Penteli, Greece
  5. 5 Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
  6. 6 Department of Oral Medicine, Euroclinic of Athens, Athens, Greece
  1. Correspondence to Dr. Chia-Cheng Li, Chia-Cheng_Li{at}


Crohn’s disease (CD) is a multifactorial, chronic immune-mediated disorder. The oral cavity is involved in 0.5% to 20% of the patients with CD. Oral manifestations of CD are sometimes nonspecific and can be overlooked by the clinicians. These manifestations may precede intestinal symptoms and can serve as indicators for early diagnosis. To increase awareness and to contribute to the standard intervention, here we report a paediatric case with persistent idiopathic swelling of the lower lip and perianal fistula. Microscopic examinations revealed multiple non-necrotising granulomas with chronic inflammation, oedema and lymphangiectasia. The patient was treated with metronidazole 500 mg and ciprofloxacin 500 mg twice a day for one month. The perioral lesions were managed with topical 0.03% tacrolimus and oral prednisone 10 mgtwice a day for one month, followed by a tapered regimen of 10 mg/day for another month. The patient’s symptoms improved without full remission at the 6-month follow-up.

  • dentistry and oral medicine
  • paediatrics (drugs and medicines)
  • rheumatology
  • gastroenterology

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  • Contributors ES is the primary care provider and documented the case. ES, JC and C-CL reviewed the case and participated in writing the manuscript. MA revised and finalised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.