PYOSTOMATITIS VEGETANS ASSOCIATED WITH CR OHNS-DISEASE

History and clinical findings: A 27-year-old man was referred to the d ermatological out-patient clinic because of inflammatory changes in th e oral mucosa of unknown cause. 5 months earlier he had been diagnosed as having Crohn's disease of the terminal ileum. On both sides of the buccal mucosa there were rough erythematous vegetations and dissemina ted miliary abscesses, which extended to the labial gingiva and the so ft palate. Further physical examination was unremarkable. Investigatio ns: Several inflammatory parameters were increased: C-reactive protein 100 mg/l, erythrocyte sedimentation rate 55/88 mm, eosinophilic catio nic protein 35.8 ng/ml (normal range 2.3-16 ng/ml). White cell count w as normal (7,25/nl), with a lymphocytopenia of 11.9%. There was no eos inophilia. Haemoglobin was reduced to 11.6 g/dl and the platelets rais ed to 526/nl. Smears of the oral mucosa showed no fungal, viral or bac terial infection. Biopsy revealed leucocytic microabscesses in the epi thelium, granulation tissue and flat ulcerations with adjoining superf icial necrotic zones. Diagnosis, treatment and course: The clinical an d histological picture as well as the association with Crohn's disease (CD) suggested pyostomatitis vegetans (PV). The PV was treated with d isinfectant mouth washes which improved the subjective findings. Budes onide was given for CD. Conclusion: PV is a rare and usually isolated condition, but it can also occur in association with a chronic gastroi ntestinal disease such as ulcerative colitis and Crohn's disease. The diagnosis of PV indicates a thorough gastroenterological investigation .