engleski

Pyostomatitis vegetans associated with inflammatory bowel disease : report of two cases

Pyostomatitis vegentans (PV) is rare benign mucocutaneus disorder usually associated with inflammatory bowel disease (IBD). We present two cases of PV associate with Crohn's disease (CD) and ulcerative colitis (UC) as well. Clinical cases: A 23-year-old woman with a history of luminal, cortisteroid dependent CD of terminal ileum and colon experienced acute pancreatitis caused by azatioprin. During pretreatment screening for biologic therapy she presented with yellow, linear pustules and multiple, little painful ulceration on erythematous labial and buccal mucosa. Deep fissures were presented on ventral tongue. The histological report revealed PV. We started with adalimumab therapy and she achieved remission of intestinal and oral pathology. A 32-year-old woman with UC presented with yellowish, slightly elevated, pustules set on an erythematous soft palatal mucosa and dorsal tongue mucosa, after stopping corticosteroid therapy. Patient was complained to severe pain which interfered with food ingestion. Histological examination showed intraepithelial and subepithelal exudate containing numerous granulocytes including eosinophils. In subepithelial stromal tissue, a mixed inflamatory infiltrate containing granulocytes, lymphocytes and plasma cells was found. We restarted with steroids and oral pathology disappeared. After discontinuing of steroids she had a recurrent of the oral manifestation, and azatioprin was added. Complete remission of PV was achieved. Later, because of persistent active colonic disease in spite of immunomodulatory therapy we started with infliximab. Our cases confirm previously reported good experience with immunomodulators and biologics in the treatment of PV. But, before using them we have to exclude an infectious etiology of PV.

ulcerative colitis; Crohn disease; pyostomatitis vegetans

nije evidentirano