ORAL ANGIOEDEMA AS INITIAL PRESENTATION OF CROHN'S DISEASE

Lip and tongue swelling have a broad differential including drug reactions, hereditary and acquired angioedema, and contact dermatitis. Crohn's disease (CD) is a chronic inflammatory bowel disease that may have oral manifestations including aphthous ulcers, cheilitis and mucosal tags. Here, we present an atypical case of CD presenting as recurrent oral angioedema. A 30-year-old female with a history of asthma and allergic rhinitis presented to allergy clinic for evaluation of recurrent lip and tongue swelling of 3 years duration, with associated lip peeling and mandibular enlargement. She had seen otolaryngology and dermatology and previously completed courses of oral steroids with only a transient reduction in swelling prior to recurrence. Labs revealed mildly elevated IgE; complement, C1 esterase inhibitor, tryptase, and mast cell markers were normal. Her symptoms were no longer responsive to oral steroids and did not improve with topical steroids, antihistamines or montelukast treatment. Patient was referred to dentistry for biopsy, which revealed CD. Minocycline and steroids were initiated along with referral to gastroenterology. Patients with recurrent or persistent angioedema are often referred for evaluation in allergy clinic. This case highlights the importance of including CD on the differential when evaluating such patients. Though isolated oral CD is rare and usually presents after intestinal diagnosis, there may be a broader scope of presentation. Correct identification is necessary for prompting intestinal evaluation and appropriate therapy. This case reinforces the utility of an interdisciplinary approach, a broad differential and consideration of biopsy in evaluation of oral angioedema.