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Non-tender labial swelling and oedema of the perioral areas, termed orofacial granulomatosis (OFG), can occur as an isolated symptom or in combination with tuberculosis, Crohn's disease and sarcoidosis. Though genetic predisposition, allergies, infections and immunological mechanisms have been suggested as causative agents, the precise aetiopathology of OFG is unknown and therapeutic options often remain unsatisfactory. We report here a case of a 14-year-old boy with permanent painless swelling ofthe lips, oral aphthosis and gingival hyperplasia, representing OFG as a first manifestation of Crohn's disease. Initially resistant to minocycline and high dosages of intravenous methylprednisone, we decided to treat the patient with a combination of the monoclonal, anti-tumour necrosis factor alpha (TNF-a) antibody infliximab and orally administered dapsone, which resulted in complete longterm remission of both clinical conditions.

acta dermato-venereologica

Orofacial Granulomatosis as First Manifestation of Crohn’s Disease: Successful Treatment of Both Conditions with a Combination of Infliximab and Dapsone