Extraintestinal manifestations of Crohn’s disease

Crohn’s disease (CD) belongs to a group of inflammatory bowel diseases (IBD) and is characterised by chronic, segmental, granulomatous inflammation with periods of exacerbation and remission, which may involve any part of the gastrointestinal tract. Crohn’s disease is diagnosed mainly in young adults, with a peak occurrence between ages 15 and 30 years. The precise pathogenesis is still not entirely identified and understood. Crohn’s disease symptomatology is non-specific and very diverse. General symptoms such as fever, weakness, and weight loss are accompanied by intestinal symptoms associated with chronic inflammation of the intestinal mucosa, such as abdominal pain and chronic diarrhoea [1, 2]. Occasionally, extraintestinal manifestations (EIMs) may occur, with a prevalence varying from 6% to 36%. The most common EIMs involve joints, skin, uvea, blood, and the hepatobiliary system. Arthropathy associated with IBD is definitely the most common EIM, clinically divided into peripheral and axial involvement. The most diverse are cutaneous manifestations, in which specific granulomatous skin lesions, non-characteristic reactive lesions, skin symptoms secondary to nutritional malabsorption, and iatrogenic skin changes are distinguished [3]. Unclear pathogenesis of EIMs in patients with CD makes treatment strategies difficult and requires a multidisciplinary approach. The aim of this work was to report a case of a CD patient with a variety of severe extraintestinal symptoms that appeared during exacerbations and undertaken treatment of the disease.
A 26-year-old female patient with a 6-year history of CD presented multiple extraintestinal manifestations that developed one year before diagnosis of the basic disease. The first symptoms appeared during pregnancy in January 2006. She complained of abdominal pain, chronic diarrhoea, and hypertrophy of labia minor and major. In October 2006, because of severe intestinal and vulvar symptoms a caesarean section was performed. In the postnatal period the patient presented a high fever and further intestinal aggravation with hemodiarrhea. The vulva underwent further growth restricting the free movement of the patient. Within one year of frequent dermatological, endocrinological, and immunological consultations, and HPV tests the correct diagnosis was not established. In December 2007, due to the appearance of perianal lesions the patient was admitted to the Department of Gastroenterology, Medical University of...


View full text...