Lip Swelling as Initial Presentation of Crohn’s Disease

Abstract

A 31-year-old woman presented with a year of recurrent lower lip swelling with associated oral ulcers (Figure A). Labs were notable for an elevated C-reactive protein and hypoalbuminemia. A punch biopsy of her lower lip showed granulomatous dermatitis with lymphangiectasia, and she was given the diagnosis of orofacial granulomatosis (Figure B). Resolution of symptoms only occurred with chronic prednisone. Subsequent onset of abdominal pain, diarrhea, and bright red blood per rectum prompted a full gastrointestinal (GI) workup for possible Crohn’s disease (CD).