Vulvar and Gluteal Manifestations of Crohn Disease | Figure 1

Vulvar and Gluteal Manifestations of Crohn Disease

A 37-year-old woman presented with recurring painful swelling and erythema of the vulva over the last year.

Despite a series of negative vaginal cultures, she was prescribed multiple courses of antifungal and antibacterial treatments, while her symptoms continued to worsen. She had no other relevant medical history except for occasional diarrhea and abdominal cramping, which were attributed to irritable bowel syndrome.

On examination, she had symmetric edema and erythema of the vulva.

Closer inspection revealed a nonulcerated, slightly friable nodule of approximately 4 mm on her right labium minus. A biopsy of this region demonstrated multiple noncaseating granulomas and mixed inflammatory infiltrates. An acid-fast stain for mycobacteria was negative. Vulvar skin ultrasonography demonstrated fistulas and increased dermal thickness with altered subcutaneous tissue.

She was encouraged to undergo colonoscopy, which showed findings suggestive of Crohn disease.

This diagnosis should be considered in a patient who has vulvar pain, edema and ulcerations not otherwise explained, whether or not gastrointestinal Crohn disease is present. The diagnosis is established with clinical history and characteristic histopathology on biopsy. Multiple biopsies may be needed, and early endoscopy is recommended to establish the diagnosis. An imaging study such as ultrasonography is sometimes used to differentiate between a specific cutaneous manifestation of Crohn disease and its complications such as perianal fistula or abscess.