Vulvar Crohn's disease in children: Diagnostic challenges and therapeutic implications from a literature review.

What To Know

The article reports a 13-year-old girl whose chronic vulvar swelling and fissures were ultimately diagnosed as metastatic Crohn's disease on vulvar biopsy; endoscopy then confirmed colonic Crohn's disease.

The authors reviewed 56 pediatric cases and found vulvar swelling — often painless and sometimes preceding intestinal diagnosis — was the most common presentation.

Pelvic MRI is useful to exclude contiguous fistulising disease, and vulvar biopsy can confirm granulomatous inflammation but may not be necessary if intestinal Crohn's is already proven and other diagnoses excluded. Treatment approaches described range from topical therapies and antibiotics to systemic immunomodulators and biologic therapy.

The review notes frequent need for escalation to anti-TNF-α therapy and sometimes dose intensification for refractory vulvar disease. Early multidisciplinary care is emphasized to reduce the risk of irreversible tissue damage.