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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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 source (direct Gemma or distilled Codex), 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".