Leupold U, Horn L C, Witzigmann H, Pohl K, Mössner J, Keim V
Abteilung Gastroenterologie und Hepatologie, Universität Leipzig.
Med Klin (Munich). 1998 Aug 15;93(8):492-6. doi: 10.1007/BF03042599.
Crohn's disease may involve all parts of the gastrointestinal tract. Extraintestinal manifestations with and without continuity to the intestine are described. The most common complications are the involvement of bone (articulations), liver and eyes. Crohn's disease of the vulva is rare and only a few cases have been reported in the literature.
The 45-year-old woman has a 15-year history of a marked chronic-inflammatory bowel disease. The diagnosis of Crohn's disease was never confirmed histologically. In 1984, she developed a painful vulvar swelling and erythema. A fungal infection was suspected and she was treated with topical antimycotic medication, but there wasn't any improvement. In July 1995, biopsies of the vulva showed a granulomatous inflammation consistent with Crohn's disease. Oral metronidazol therapy (20 mg/kg/day) was started. After 2 months, the erythema had healed completely but the vulvar swelling remained.
The treatment of this extraintestinal manifestation is very difficult. Systemic or topical application of steroids is without response in most cases. Surgical excision showed good results in a few cases. A long-term treatment with oral metronidazol 20 mg/kg/day could be a chance for healing without adverse effects.
克罗恩病可累及胃肠道的所有部位。描述了有或无肠道连续性的肠外表现。最常见的并发症是骨骼（关节）、肝脏和眼睛受累。外阴克罗恩病罕见，文献中仅报道了少数病例。
一名45岁女性有15年明显的慢性炎症性肠病病史。克罗恩病的诊断从未经组织学证实。1984年，她出现外阴疼痛性肿胀和红斑。怀疑有真菌感染，她接受了局部抗真菌药物治疗，但没有任何改善。1995年7月，外阴活检显示符合克罗恩病的肉芽肿性炎症。开始口服甲硝唑治疗（20mg/kg/天）。2个月后，红斑完全愈合，但外阴肿胀仍存在。
这种肠外表现的治疗非常困难。在大多数情况下，全身或局部应用类固醇均无反应。手术切除在少数病例中显示出良好效果。长期口服甲硝唑20mg/kg/天可能是一种无不良反应的治愈机会。
