Group 4

Crohn’s Disease case scenario

Narrator:
A 13-year-old boy was referred to the dental clinic with abnormal persistent
swelling of the lower lip and right cheek, with systemic symptoms like diarrhea,
fever, abdominal pain, cramping, and pain when defecating.

Section 1 : History
*Dentist: Salam Alikom, What is your name?

=Child: Nawaf Alghamdi

*Dentist: How old are you?

=Child: Thirteen years old and I am intermediate school student

*Dentist: What is your chief complain?

*Child parent: Lip swelling.

*Child parent: The swelling of his lower lip and right cheek is persistent and
didn’t go, he is complaining about abdominal pain, fever, and diarrhea.

*Dentist: When did you notice the swelling of lip and cheek?

*Child parent: 5days ago

*Dentist: does your child have any medical conditions or drug therapy?
*Child parent: No, but since about 1-2 weeks he feels fatigue with fever,
abdominal pain, and diarrhea. I thought it is a normal flu. So, I gave him Tylenol.

*Dentist: what was his last visit to the dentist?

*Child parent: he has never visited dentist.

*Dentist: has anyone of the family has the same symptoms?

*Child parent: yes, his grandmother

Question 1

What other question you may ask the patient about?

1- Weight gain or loss

2- Mouth sores
3- Blood on his stool
4- Pain or drainage near or around the anus
5- Any previous investigations or treatments

a- 1,3,4
b- 2,3,4
c- 3,4
d- All of the above

2. Clinical examination section:

Narrator: All the following vital signs were taken

- Fever (40.0C)
- Blood pressure (115/69 mm Hg)
- Heart rate (73 bpm)
- Respiratory rate (17 bpm)

Extraoral examination revealed:

- swelling of the lower lip

- swelling of right cheek

The skin above the swelling did not

Exhibit increased local surface.

temperature or redness.
Question2

What is the suggested cause for lip swelling?

a- Physiologic
b- Allergic reaction
c- Autoimmune disease
d- Endocrine disturbance

*Dentist: I noticed there is a swelling on the lower lip of your child, is this is the
first time he experiences this swelling?

=child parent: yes, and it is starts after he was suffering from his abdominal pain.

Narrator:
Intraoral examination revealed:

- Diffuse lip and buccal mucosal swellings

- Non-plaque induced gingivitis
- Aphthous ulcer
-

Narrator:
DD:

1. Crohn’s disease
2. Foreign-body reactions
3. Sarcoidosis
4. Typical and atypical mycobacterial infection
5. Fungal sepsis
3. Investigations section
Question 3

What other investigation could be done by the dentist?

A. Referral for Endoscopy

B. ASCA/pANCA TEST
C. CRP- ESR TEST
D. Complete blood cell count
E. Biopsy
F. All of the above

The dentist ordered for

 An oral biopsy was taken from the swollen lip.

Lab investigations results:

 Histological examination with ( Haematoxylin and Eosin stain)

shows the presence of non-caseating granulomas into oral
biopsy of oral CD

Question 4

What is the test that used for detecting malnutrition deficiency?

A. Serum iron
B. PGRN
C. HBV markers
D. CRP
4. Diagnosis section

From the clinical extraoral and intraoral findings and the

laboratory examination along with patient medical history of
sudden onset of fever, abdominal pain, diarrhea, and pain when
defecating and the family history which his grandmother has the
same manifestation. It has been confirmed the diagnosis of Crohn’s
disease for this child.

5.Management section
He target the systemic therapy with anti-inflammation
(corticosteroids) and immune suppressive drugs (Cyclosporine).

1. Follow up.
2. Referral to internal physician then endoscopy

Follow-up
After treatment and follow up for one-year the patient shows no
signs of reoccurrence.