{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T22:50:07Z","timestamp":1762642207591,"version":"3.44.0"},"reference-count":6,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,4,1]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>Crohn\u2019s disease (CD) is a multifactorial, chronic immune-mediated disorder. The oral cavity is involved in 0.5% to 20% of the patients with CD. Oral manifestations of CD are sometimes nonspecific and can be overlooked by the clinicians. These manifestations may precede intestinal symptoms and can serve as indicators for early diagnosis. To increase awareness and to contribute to the standard intervention, here we report a paediatric case with persistent idiopathic swelling of the lower lip and perianal fistula. Microscopic examinations revealed multiple non-necrotising granulomas with chronic inflammation, oedema and lymphangiectasia. The patient was treated with metronidazole 500\u2009mg and ciprofloxacin 500\u2009mg twice a day for one\u2009month. The perioral lesions were managed with topical 0.03% tacrolimus and oral prednisone 10\u2009mgtwice a day for one\u2009month, followed by a tapered regimen of 10\u2009mg\/day for another month. The patient\u2019s symptoms improved without full remission at the 6-month follow-up.<\/jats:p>","DOI":"10.1136\/bcr-2019-229916","type":"journal-article","created":{"date-parts":[[2019,4,20]],"date-time":"2019-04-20T12:15:26Z","timestamp":1555762526000},"page":"e229916","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Crohn\u2019s disease initiated with extraintestinal features"],"prefix":"10.1136","volume":"12","author":[{"given":"Jeffrey","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Nutrition and Hepatology, Boston Childrens Hospital, Boston, Massachusetts, USA"},{"name":"Department of Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia-Cheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Achtari","sequence":"additional","affiliation":[{"name":"Department of General and Special Care Dentistry, Penteli Children\u2019s Hospital, Penteli, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleana","family":"Stoufi","sequence":"additional","affiliation":[{"name":"Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA"},{"name":"Department of Oral Medicine, Euroclinic of Athens, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,4,20]]},"reference":[{"key":"2025082711255102000_12.4.e229916.1","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1016\/S0140-6736(16)31711-1","article-title":"Crohn\u2019s disease","volume":"389","author":"Torres","year":"2017","journal-title":"Lancet"},{"key":"2025082711255102000_12.4.e229916.2","doi-asserted-by":"publisher","DOI":"10.1136\/gut.23.3.198"},{"key":"2025082711255102000_12.4.e229916.3","doi-asserted-by":"publisher","DOI":"10.3109\/07853890903559724"},{"key":"2025082711255102000_12.4.e229916.4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1601-0825.2011.01811.x","article-title":"Inflammatory bowel disease","volume":"18","author":"Boirivant","year":"2012","journal-title":"Oral Dis"},{"key":"2025082711255102000_12.4.e229916.5","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1111\/apa.13686","article-title":"Crohn\u2019s disease should be considered in children with inflammatory oral lesions","volume":"106","author":"Skrzat","year":"2017","journal-title":"Acta Paediatr"},{"key":"2025082711255102000_12.4.e229916.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32448-0"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-229916","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:26:00Z","timestamp":1756319160000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-229916"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":6,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,4,20]]},"published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1136\/bcr-2019-229916"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-229916","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}