Smells like M. Crohn: Two Case Reports of Nasal Manifestations of Crohn’s Disease

What To Know

These two case reports describe nasal and nasopharyngeal inflammation as rare extraintestinal manifestations of Crohn’s disease. One patient had nasal disease at initial presentation with concurrent mild intestinal inflammation; the other developed persistent nasal lesions despite intestinal remission.

Histopathology and ileocolonoscopy helped establish the diagnosis. Treatments described included topical/systemic corticosteroids and azathioprine, with escalation to the anti-TNF biologic adalimumab leading to resolution of nasal disease in the second case.

What to watch for: recurrent nosebleeds, nasal crusting, septal perforation, persistent rhinorrhea, or unexplained inflammatory lesions in the upper airway in people with known or suspected Crohn’s disease may represent an extraintestinal manifestation and warrant ENT evaluation and biopsy when appropriate.

Treatment context: the cases report response to systemic immunosuppression and to biologic therapy (adalimumab) after failure of initial measures in one patient; these are individual cases and not evidence of general treatment effectiveness.

Interpretation: this report raises awareness of a rare presentation so clinicians can consider Crohn’s disease in differential diagnosis of chronic nasal inflammation, but management should be individualized and guided by specialists.