37 Refractory Vulvar Crohn’s Disease Successfully Treated With Intra-Lesional Methylprednisolone: A Rare Case Report
Bibliographic record
Abstract
Background: Vulvar Crohn’s disease (VCD) is a rare manifestation of cutaneous Crohn’s disease (CCD) with fewer than 110 cases reported since 1965. It is characterised by granulomatous genital inflammation that is non-contiguous with the gastrointestinal tract. Methods: We present a 33-year-old female with ileo-colonic CD (Montreal A2 L2 B3p) with biopsy-proven VCD diagnosed in 2015 and previously managed on adalimumab and azathioprine. Between 2016 and 2021, she had recurrent admissions with VCD flares requiring repeated courses of systemic corticosteroids with diminishing effect. In 2022, Ileo-colonoscopy and magnetic resonance (MR) enterography showed no active ileo-colonic inflammation despite ongoing vulvar symptoms. MR pelvis revealed a small trans-sphincteric fistula unrelated to the vulva. Faecal calprotectin was elevated at 102 µg/g. Treatment was escalated to infliximab 10 mg/kg with azathioprine, followed by trials of topical tacrolimus, and later upadacitinib. The Dermatology team recommended a vulva re-biopsy, which excluded vulvar intra-epithelial neoplasia but confirmed non-caseating granulomas. Recurrent VCD flares prompted further escalation to risankizumab with subcutaneous methotrexate. Following a multidisciplinary team review, intra-lesional methylprednisolone injections were initiated, resulting in rapid symptomatic improvement and clinical remission of VCD. Results: The patient remains in clinical remission on 8-weekly risankizumab, weekly methotrexate, and intra-lesional Depo-Medrone (methylprednisolone acetate) 120 mg diluted in normal saline injections as needed. Conclusions: This case highlights the complexities involved in diagnosing and managing this rare clinical manifestation of CD and the asynchrony between VCD and intestinal disease. A multidisciplinary team approach is pivotal for individualising treatment in refractory cases. Intra-lesional corticosteroids may serve as an effective therapeutic option for patients with isolated and treatment-refractory VCD.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".