26118 Cutaneous Crohn masquerading as hidradenitis suppurativa

Abstract

A 20-year-old female presented for possible hidradenitis suppurativa. She had an itchy, painful lesion on her labia majora for >2 years, with flares every few weeks. Physical examination was significant for hyperpigmented and erythematous plaques with fissuring of the labia majora and perianal region. She also reported constipation and abdominal pain but denied bloody stools. Previously worked up by pediatric gastroenterology (GI) 2 years prior for a 15-lb unintentional weight loss and constipation. Constipation had been ongoing for >10 years. Esophagogastroduodenoscopy, colonoscopy, and CT enterography were unremarkable other than anal papillomas. On physical examination, she had hemorrhoids, rectal fissures, and labial swelling. Inflammatory bowel disease (IBD) was ruled out by GI. She was prescribed polyethylene-glycol-3350 by GI for constipation. General surgery also excised the anal papillomas. Based on history and clinical exam, we were concerned for cutaneous Crohn disease. We started her on adalimumab, slow prednisone (40 mg) taper, and silver sulfadiazine. We also referred her back to GI for re-evaluation for IBD. Patient now reported blood associated with straining during bowel movements. GI noted perianal inflammation and repeated a colonoscopy, which showed a benign anal stricture, anorectal ulcers, and sigmoid ulcers. Rectal and sigmoid biopsies showed acute and chronic colitis with ulceration. She was formally diagnosed with Crohn disease. Patient reported full resolution of her cutaneous lesions over a 4-month period on adalimumab and the prednisone taper. Cutaneous genital and perianal fissures in the setting of gastrointestinal symptoms warrant evaluation for IBD even with prior negative workup.