Anogenital granulomatosis as extradigestive Crohn disease: Efficiency of adalimumab therapy

Introduction. - Anogenital granulomatosis is a rare disease which is actually considered as a metastatic lesion of Crohn disease (CD). Observation. - A 53-year-old woman presented with intermittent vulvar and anoperineal lesions since adolescence, seeping and painful during sexual intercourse. We observed an infiltrative and asymmetric oedema of labia majora, perianal oedematous vegetative pseudo-marisca, and groin fold and perianal linear ``knife-like'' ulcerations. Pathological analysis revealed noncaseating giant cell granulomas. The diagnosis of CD was made. Investigations did not show any intestinal involvement. Anti-TNF alpha therapy with adalimumab was dramatically efficient. Conclusion. - Anogenital granulomatosis often precedes intestinal lesions but may also be isolated as in our case. Although treatment is difficult, anti-TNFa seem promising tools. (C) 2019 Societe Nationale Francaise de Medecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.