A 38-year-old single male patient presented seeking advice for oral lesions, which had begun 6 months earlier (Fig. 1A and B). He was otherwise healthy but reported recent fatigue, abdominal pain, and a 6-month unintentional weight loss of 10 kg. Bacteriological and mycological samples of the lesions were negative. Biopsies of the labial commissure and lower lip both disclosed noncaseous granulomas in the lamina propria. Complete examination of the skin and anal mucosa were normal.
CD and ulcerative colitis (UC) are the most common inflammatory bowel diseases (IBD). CD usually involves any region of the gastrointestinal system but predominantly the terminal portion of the ileum and initial portion of the colon (Pereira and Munerato, 2016). Up to one third of patients develop extraintestinal manifestations of the disease, including cutaneous lesions, especially inside the oral cavity. The prevalence of oral lesions ranges from 5% to 25% of all affected patients (Lourenço et al., 2010). Oral manifestations associated with CD can precede gastrointestinal lesions and may suggest the diagnosis (Pereira and Munerato, 2016).
Patients with active CD have a higher degree of oral lesions, but their type has no relationship with the activity of the disease (Pereira and Munerato, 2016). The most common oral sites affected are the lips, gingiva, and mandibular vestibule, and different types of lesions can coexist in one patient. The oral lesions are classified as specific or nonspecific to CD depending on the presence or absence of granulomas on histopathology, respectively (Lourenço et al., 2010; Pereira and Munerato, 2016).