This 13-year-old girl was referred for evaluation of oral ulcerations, facial swelling and oral pain. A concomitant history of swelling involving the lower lip, cheeks and cervical lymphadenopathy was also noted. Last year she missed 27 school days due to abdominal pain. She had a tonsillectomy at 2 years of age and complained of severe depression and anxiety, nasal stuffiness, asthma, and abdominal pain. She had multiple treatments including oral antibiotics, parenteral antibiotics, chlorhexidine rinses, and topical steroids. A biopsy of the buccal mucosa revealed focal and diffuse chronic inflammation with scattered non-caseating epitheloid granulomas. Special stains were negative for acid fast bacteria, fungus, and polarizing microscopy was negative for foreign material. Further evaluation by pediatric gastroenterology including upper and lower gastrointestinal tract studies showed characteristic changes of Crohn disease. Oral and gastrointestinal lesions and symptoms resolved with treatment of her inflammatory bowel disease.
cobblestoning of the mucosa with linear ulcers and hyperplastic folds