Published online August 11, 2005
PEDIATRICS Vol. 116 No. 3 September 2005, pp. e439-e444 (doi:10.1542/peds.2004-2281)
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ELECTRONIC ARTICLE

Asymptomatic Inflammatory Bowel Disease Presenting With Mucocutaneous Findings

Sheila S. Galbraith, MD*, Beth A. Drolet, MD*, Subra Kugathasan, MD{ddagger}, Amy S. Paller, MD§ and Nancy B. Esterly, MD*

* Department of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
{ddagger} Department of Gastroenterology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
§ Department of Dermatology and Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

Although inflammatory bowel disease (IBD) typically presents with gastrointestinal complaints, mucocutaneous lesions are commonly associated and can precede gastrointestinal symptoms, thereby alerting the clinician to the diagnosis of IBD before the onset of gastrointestinal symptoms. Nine children are reported who had no gastrointestinal symptoms suggestive of IBD but presented with mucocutaneous findings of IBD and were subsequently diagnosed with Crohn's disease or ulcerative colitis based on characteristic features on gastrointestinal endoscopy and/or biopsies. The majority of the patients had oral and perianal lesions. We believe that IBD is a common etiology for persistent oral lesions in the pediatric population. In addition to a good history, children with unexplained oral mucous membrane lesions should have an examination of the rectal and genital mucosa as well as tests for complete blood count, iron levels, sedimentation rate, albumin, and occult blood in the stool with endoscopy and biopsies to rule out IBD if indicated.

Key Words: Crohn's disease • cutaneous • inflammatory bowel disease • oral • pediatrics

Abbreviations: IBD, inflammatory bowel disease • 6-MP, 6-mercaptopurine • ESR, erythrocyte sedimentation rate

Accepted Mar 31, 2005.