Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA;
Skinmed. 2023 Nov 10;21(5):366-369. eCollection 2023.
A 36-year-old woman presented to the emergency department with a 1-day history of purulent perianal and vulvar discharge. She had a 25-year history of Crohn's disease (CD), and 13 years prior had received a total colectomy with end ileostomy. She had vulvar biopsies 5 years prior to presentation, demonstrating noncaseating granulomas consistent with metastatic Crohn's disease (MCD). Throughout the course of her disease, she had a failed treatment with adalimumab, certolizumab, methotrexate, and 6-mercaptopurine. She had received a radical vulvectomy 1 year prior to presenting to control recurrent vulvar abscesses and MCD while receiving monthly subcutaneous infliximab 10 mg/kg body weight. Dermatology was consulted at presentation, and the physical examination revealed tender, linear ulcerations with a granulated appearance and depigmentation on the natal cleft and vulva (Figures 1 and 2). Computerized tomography (CT) scan of the abdomen and pelvis indicated thickening of soft tissue without evidence of abscesses, fluid collection, or fistulae. Given the distribution and morphology of lesions with a history of biopsy-proven MCD, the patient was diagnosed with a flare of MCD.
一位 36 岁女性因 1 天的脓性肛周和外阴分泌物而到急诊就诊。她有 25 年的克罗恩病（CD）病史，13 年前曾接受过全结肠切除术和末端回肠造口术。她在就诊前 5 年曾接受过外阴活检，显示符合转移性克罗恩病（MCD）的非干酪样肉芽肿。在她的疾病过程中，她曾使用阿达木单抗、certolizumab、甲氨蝶呤和 6-巯基嘌呤治疗失败。在就诊前 1 年，她接受了根治性外阴切除术，以控制复发性外阴脓肿和 MCD，同时每月接受 10mg/kg 体重的皮下英夫利昔单抗治疗。就诊时皮肤科进行了会诊，体格检查显示在会阴部和外阴有触痛的线状溃疡，呈颗粒状外观和色素减退（图 1 和 2）。腹部和骨盆的计算机断层扫描（CT）显示软组织增厚，没有脓肿、积液或瘘管的证据。鉴于病变的分布和形态，结合活检证实的 MCD 病史，该患者被诊断为 MCD 发作。
