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Vulvar Manifestations of Crohn's Disease

Foo, Wen-Chi MD; Papalas, John A MD; Robboy, Stanley J MD; Selim, Maria A MD

American Journal of Dermatopathology: August 2011 - Volume 33 - Issue 6 - pp 588-593
doi: 10.1097/DAD.0b013e31820a2635
Original Study

Crohn's disease is an inflammatory bowel disorder with several well-known extraintestinal manifestations, such as erythema nodosum, uveitis, and arthritis. Less commonly observed are vulvar manifestations, which have primarily been discussed in case reports or small case series. These cases generally highlight patients with histopathology limited to noncaseating granulomas. As these histological findings are identified in bowel biopsies from only approximately 50% of patients with gastrointestinal Crohn's disease, there is likely an under-recognition and underdiagnosis of vulvar lesions as Crohn's disease manifestations. We describe the largest case series to date involving patients with vulvar Crohn's disease, discuss the varied clinical presentations, and describe the histopathological findings, which include noncaseating granulomas, ulcerations, lymphatic lesions, and even dysplasia and carcinoma. Our findings underscore the importance of keeping vulvar Crohn's disease on the differential diagnosis when faced with a range of vulvar symptoms and suggest that regular gynecological surveillance in patients with Crohn's disease may be of benefit.

From the Department of Pathology, Duke University Medical Center, Durham, NC.

Reprints: Wen-Chi Foo, MD, Department of Pathology, Duke University Medical Center, Box 3712, Durham, NC 27710 (e-mail: foo00001@mc.duke.edu).

© 2011 Lippincott Williams & Wilkins, Inc.