(33) Crohn's disease of the upper lip
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Case reports FIGURE 2. Skin biopsy ( x 98) showing well-defined granulomata. from 30 mm/h to 6 mm/h. In 1973 barium meal showed no abnormality. Colonoscopy showed numerous sessile ulcers and pseudopolyps in the descending colon and upper sigmoid. In 1976, treatment was discontinued and he remains in spontaneous remission. In April 1982 he presented with a 2-month history of an asymptomatic eruption which first appeared over the nape of the neck and rapidly became widespread. The lesions were particularly prominent over the lower limbs (Fig. i). Examination. There was a difFuse, maculo-papular rash, suggestive of a lichenoid eruption. No oral, ocular or genital lesions were present. History (1982). The epidermis showed some spongiosis and patchy hyperkeratosis. In the dermis, there were well-circumscribed epithelioid granulomas with a moderate mixed inflammatory infiltrate, consisting of plasma cells, lymphocytes and some polymorphs (Fig. 2). In July 1982 he developed right iridocyclitis. Comment. This patient is of interest because he lacked the typical granulomas of Crohn's disease in the segmemal colonic lesion, but developed them diffusely in the skin subsequently, in the absence of bowel disease. Cutaneous granulomas in Crohn's disease usually form close to the mouth and perineum, and it is unusual for them to develop away from these sites. (33) Crohn's disease of the upper lip OLIVER SCOTT Si Luke's Hospital, Guildford D.W., female, aged 23 years. History. This patient underwent colectomy for Crohn's disease by Mr A.H.Amery at Frimley
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Transcript of (33) Crohn's disease of the upper lip
Case reports
FIGURE 2. Skin biopsy ( x 98) showing well-defined granulomata.
from 30 mm/h to 6 mm/h. In 1973 barium meal showed no abnormality. Colonoscopy showednumerous sessile ulcers and pseudopolyps in the descending colon and upper sigmoid. In 1976,treatment was discontinued and he remains in spontaneous remission.
In April 1982 he presented with a 2-month history of an asymptomatic eruption which firstappeared over the nape of the neck and rapidly became widespread. The lesions wereparticularly prominent over the lower limbs (Fig. i).
Examination. There was a difFuse, maculo-papular rash, suggestive of a lichenoid eruption.No oral, ocular or genital lesions were present.
History (1982). The epidermis showed some spongiosis and patchy hyperkeratosis. In thedermis, there were well-circumscribed epithelioid granulomas with a moderate mixedinflammatory infiltrate, consisting of plasma cells, lymphocytes and some polymorphs (Fig. 2).
In July 1982 he developed right iridocyclitis.Comment. This patient is of interest because he lacked the typical granulomas of Crohn's
disease in the segmemal colonic lesion, but developed them diffusely in the skin subsequently, inthe absence of bowel disease. Cutaneous granulomas in Crohn's disease usually form close to themouth and perineum, and it is unusual for them to develop away from these sites.
(33) Crohn's disease of the upper lip
OLIVER SCOTT
Si Luke's Hospital, Guildford
D.W., female, aged 23 years.History. This patient underwent colectomy for Crohn's disease by Mr A.H.Amery at Frimley
Case reports
FIGURE I. Crohn's disease of upper lip.
Park Hospital in 1978. The histological report by Professor Norman Gibbs was typical of thedisease.
In 1979, she developed swelling on the upper lip when, at that time, there were no other signsof active Crohn's Disease (Fig. i).
Histology by Professor Gibbs showed a similar epithelial giant cell granuloma in the dermis,similar to the Crohn's disease found in the colon of this patient. She still has a certain amount ofabdominal discomfort but the condition has been controlled by prednisone.
(34) Crohn*s disease of the perineum
S.MARSTON, J.J.CREAM AND J.S.STEWART
West Middlesex Hospital, hlewortfi
N.G., female, aged 34 years.History. This patient has an 8-year history of granulomatous disease of the perineum for
which no infective cause has been found. Clinical findings in 1976 included anal fissures,aphthoid ulcers over the labia majora, fenestration of the right labium minus and a fistula fromthe fourchette to the rectum. Biopsies of the affected areas showed 'sarcoidal' granulomas and noorganisms were found. Although there were no bowel symptoms or signs, a diagnosis of Crohn'sdisease was made. She was treated with oral prednisolone (40 mg to 5 mg daily) from 1976 to1982 and during this period has had two children by Caesarean section. She remains well andfree from intestinal disease both clinically, radiologically and endoscopically. The perineum isessentially unchanged.
