Oral Crohn's disease: a favorable clinical response with delayed-release triamcinolone acetonide intralesional injections

a 28 year-old man was referred to our Oral Medicine Unit by her general practitioner for persistent intraoral inflammatory hyperplastic tissue with fissuring ("cobblestoning"), localized at the left cheek and mucosal tags localized at the left lower gingival fornix. The patient reported of suffering from intestinal CD since three years, treated by mesalazine 500 mg tablets b.i.d. At that time, he had no fever, abdominal pain, or diarrhea. The disease was very well controlled and no other organ or system was involved.An oral biopsy was taken and the histology with haematoxylin/eosin revealed a papillary hyperplastic epithelium with a prominent lymphocites and hystiocytes infiltrate arranging into non-caseating granulomas and, perivascular mononuclear cell infiltration in the underlying connective tissue. The diagnosis of oral CD was confirmed and the patient received intralesional corticosteroid injections.Four weeks later, all oral lesions were completely healed without any side effect. The patient was recalled and seen every month for six months, showing a complete clinical remission at the last follow-up.