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CROHN DISEASE AND CHEILITIS
A Alhussaini, Decker Butzner, Helen Machida
Department of Pediatric Gastroenterology and Nutrition, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta
The association between granulomatous cheilitis (GC) and crohn disease (CD) has been reported rarely in the pediatric literature.
CASE HISTORY: An 8 yr old boy presented at age 6 yr with abdominal pain, non bloody diarrhea , weight loss and joint pain . Colonoscopy demonstrated non-contiguous erythema, friability and multiple aphthus ulcers consistent with the appearance of crohn colitis which was managed with steroids and 5-ASA. Within 24 months, he had multiple relapses of his intestinal symptoms accompanied by recurrent,nonpruritic and nonpainful marked swelling of both lips on tapering the steroid dose to 10-15mg/day. His symptoms improve on increasing the steroid dose. Inadequate response to steroid therapy led to a switch to 6-mp therapy without significant improvement. Lip biopsy showed a diffuse infiltrate of lymphocytes, plasma cells and mast cels. A trial of infliximab infusions is planned to control his symptoms.
CONCLUSION: The association between CD and cheilitis suggest that paediatricians should be alerted by the lip swelling in children with CD and should rule out CD in patients with cheilitis. Cheilitis, which develops in association with CD, can serve as an indication of uncontrolled CD.