title: Buccal localization of Crohn's disease with long-term infliximab therapy: a case report.
abstract: BACKGROUND
  Cheilitis granulomatosa causes persistent idiopathic lip swelling and ulceration and it can sometimes be recognized as a unique or early manifestation of Crohn's disease. Spontaneous remission is rare and with the lack of controlled trials, different therapeutic approaches have been used. Some cases have been treated with an exclusion diet in the attempt to rule out diet allergens, while the most popular treatments include antibiotics such as tetracycline and clofazimine tranilast, benzocaine topical or intralesional steroids, and cheiloplasty, with different outcomes.
  
  
  METHODS
  We describe the case of a 23-year-old Caucasian man, primarily diagnosed with cheilitis granulomatosa for a severe lower lip swelling, and then with Crohn's disease of the terminal ileum and anus. Treatment of Crohn's disease with an anti-tumor necrosis factor alpha agent (infliximab) successfully induced remission of both the gastrointestinal disease and the oral lesion.
  
  
  CONCLUSIONS
  Our recommendation is that physicians should be able to recognize cheilitis granulomatosa as a possible marker of a more complex systemic disease and proceed first with an accurate physical examination, and further suggest investigations of the bowel. In cases of Crohn's disease, a therapy with biological agents can be successful.
authors.affiliation: Gastroenterology Unit, Department of Medicine and Surgery, University of Salerno, Baronissi Campus, via S, Allende, 84081 Baronissi, Salerno, Italy. cciacci@unisa.it.
authors.forename: Carolina
authors.initials: C
authors.lastname: Ciacci
authors.forename: Cristina
authors.initials: C
authors.lastname: Bucci
authors.forename: Fabiana
authors.initials: F
authors.lastname: Zingone
authors.forename: Paola
authors.initials: P
authors.lastname: Iovino
authors.forename: Massimo
authors.initials: M
authors.lastname: Amato
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003113:Colonoscopy; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008556:Melkersson-Rosenthal Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012074:Remission Induction; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D000069285:Infliximab