[Vulvar involvement as a rare extra-intestinal manifestation of Crohn disease].
BACKGROUND
Crohn's disease may involve all parts of the gastrointestinal tract. Extraintestinal manifestations with and without continuity to the intestine are described. The most common complications are the involvement of bone (articulations), liver and eyes. Crohn's disease of the vulva is rare and only a few cases have been reported in the literature.


METHODS
The 45-year-old woman has a 15-year history of a marked chronic-inflammatory bowel disease. The diagnosis of Crohn's disease was never confirmed histologically. In 1984, she developed a painful vulvar swelling and erythema. A fungal infection was suspected and she was treated with topical antimycotic medication, but there wasn't any improvement. In July 1995, biopsies of the vulva showed a granulomatous inflammation consistent with Crohn's disease. Oral metronidazol therapy (20 mg/kg/day) was started. After 2 months, the erythema had healed completely but the vulvar swelling remained.


CONCLUSIONS
The treatment of this extraintestinal manifestation is very difficult. Systemic or topical application of steroids is without response in most cases. Surgical excision showed good results in a few cases. A long-term treatment with oral metronidazol 20 mg/kg/day could be a chance for healing without adverse effects.
Leupold
U
U
Abteilung Gastroenterologie und Hepatologie, Universität Leipzig.
Horn
L C
LC
Witzigmann
H
H
Pohl
K
K
Mössner
J
J
Keim
V
V
D000284:Administration, Oral; D000890:Anti-Infective Agents / Q000008:administration & dosage; D001706:Biopsy; D003424:Crohn Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D014844:Vulva / Q000473:pathology; D014845:Vulvar Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology
D000890:Anti-Infective Agents; D008795:Metronidazole