title: Unusual manifestations of a common gastrointestinal disorder.
abstract: We present an instructive case of a 13-year old male who presented with bilateral scrotal redness, swelling and tenderness, but with a normal testicular exam. His scrotal swelling persisted despite treatment with intravenous antibiotics, and on further history he reported 2 years of intermittent upper lip swelling. After a referral to a dermatologist, a lip biopsy showed granulomatous changes and he was referred to the gastroenterology department. A gastroscopy and colonoscopy was performed and histology confirmed non-caseating granulomas consistent with Crohn's disease (CD). Eighteen months after the diagnosis of CD he developed perianal disease with a fistula and distal anal stricture. He was successfully treated with insertion of a seton and escalation of therapy to azathioprine and infliximab. CD is a phenotypically diverse chronic inflammatory condition with an increasing incidence in Australia and other Western countries. Non-typical presentations, such as perianal manifestations or orofacial granulomatosis, can be the only presenting symptom in CD, and this highlights the importance for a high degree of clinical suspicion. Genital involvement is rare, but reported.
authors.affiliation: Department of Gastroenterology, Royal Children's Hospital, Australia; Department of Paediatrics, Royal Children's Hospital, Australia.
authors.forename: Karthik
authors.initials: K
authors.lastname: Rajah
authors.forename: Mark R
authors.initials: MR
authors.lastname: Oliver
authors.forename: Liz
authors.initials: L
authors.lastname: McLeod
authors.forename: David
authors.initials: D
authors.lastname: Orchard
authors.forename: Marcelo
authors.initials: M
authors.lastname: Leal
mesh_terms: D000293:Adolescent; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004487:Edema / Q000209:etiology; D051261:Granulomatosis, Orofacial / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012611:Scrotum / Q000473:pathology*; D013733:Testicular Diseases / Q000209:etiology*
keywords: Crohn's; IBD; OFG; children; perianal; scrotum