Cutaneous manifestation in the vulvar area as an early symptom of Crohn's disease in an 11-year old girl – Beneficial effects of exclusive enteral nutrition

Skin manifestations, such as non-contiguous metastatic lesions, can occur along with other parenteral symptoms in Crohn's disease. However, vulvar manifestations of metas-tatic Crohn's disease are rare in children. Skin manifestations in the genital area may precede gastrointestinal symptoms even by several years, so the diagnosis of Crohn's disease and implementing the appropriate treatment is often difficult and delayed. This study discusses a case of an 11-year-old girl with metastatic Crohn's disease whose primary symptom was painless swelling in the labia majora. The endoscopic examination of the remaining skin lesions carried out after 3 years confirmed Crohn's disease. Initially the combined therapy with metronidazole and mesalazine gave partial recovery. Then, in accordance with the Crohn's disease treatment guidelines, the girl was subjected to an exclusive enteral nutrition with subsequently very good results. Currently, the girl is being treated with azathioprine, her general condition is good, and vulvar lesions have completely resolved.