Published in:
18-02-2023 | Infliximab | Multicenter Seminars: IBD (MUSE: IBD)
On a Knife’s Edge: Management of Vulvar Cutaneous Crohn’s Disease
Authors:
Nicole S. Evans, Fernando S. Velayos
Published in:
Digestive Diseases and Sciences
|
Issue 4/2023
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Excerpt
A 38-year-old female diagnosed with perianal and Crohn’s colitis at age 19 underwent subtotal colectomy at age 31 due to unresponsiveness of her disease to steroids, mesalamine, azathioprine, infliximab, and adalimumab. Surgical pathology showed pancolitis with active disease extending from the ascending colon to the sigmoid margin. She subsequently underwent a completion proctectomy with end-ileostomy due to ongoing purulent drainage from her perianal region despite post-operative use of vedolizumab and seton placement. Four years after that surgery, she reported the onset of a painful scaly vulvar rash with deep linear “knife-like” ulcers and intermittent purulent drainage. Vulvar biopsy showed non-caseating granulomatous inflammation extending into the deep dermis without evidence of dysplasia or malignancy. Infectious and immunohistochemical stains, including acid-fast bacteria (AFB), Gomori methenamine silver (GMS) to detect fungi, and herpes simplex virus (HSV) were negative. Based on the clinical and pathologic findings, she was diagnosed with cutaneous Crohn’s disease of the vulva for which therapy with ustekinumab was initiated. …