Citation Information :
Nijhawan S, Nijhawan M, Agarwal S, Goel P, Jain S, Sharma A, Meherda A. Refractory Crohn's Disease of External Genitalia in a Female Successfully Treated with Adalimumab. J Mahatma Gandhi Univ Med Sci Tech 2018; 3 (3):105-107.
Crohn's disease (CD) is a chronic inflammatory bowel disease with granulomas and ulcers in the bowel. Cutaneous lesions may occur as a totally separate entity without involvement of gastrointestinal (GI) tract, in which case it is termed as metastatic Crohn's disease. Gynecologic involvement is infrequent and difficult to diagnose. A 23-year-old female presented to us with complaints of vulvar swelling and multiple, oval to linear, typical knife cutting deep ulcers on the perineal folds since 6 years. We performed a biopsy, which showed follicular plugging with epitheloid cell granuloma in subcutis and foci of chronic inflammation. The list of differential diagnosis included cutaneous tuberculosis, sarcoidosis, deep fungal infection, lymphogranuloma venerum (LGV), and Crohn's disease of vulva. Clinical correlation with investigations leads to a diagnosis of Crohn's disease of vulva by exclusion. Patient was earlier treated with oral steroids, antibiotics, and immunosuppressants like azathioprine but showed only mild improvement. In view of previous nonresponse, the condition was regarded as a refractory one. We thus planned biological therapy in the form of adalimumab. The patient showed a significant improvement in ulcers.
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