Tonsillar Crohn's Disease

A 49-year-old male patient with Crohn's disease for 18 years, characterized by ileocolonic involvement and inflammatory behavior, presented with tonsillar pain. He had been treated with adalimumab for 10 years with an optimized dose for the past 6 years, and had previously been treated with azathioprine. Physical examination revealed an enlarged right tonsil with vegetation (Figures 1 and 2). The patient also had diarrhea and colonic histological activity with a symptomatic response to budesonide. No endoscopy was performed. Oroscopy with vegetation in the right tonsil. Tonsil vegetation. The patient had been tested for tuberculosis with a tuberculin skin test and chest x-ray, and a tonsillar biopsy was performed. The biopsy revealed chronic granulomatous inflammation with multinucleated giant cells and marked acute ulceration (Figure 3). Considering the literature and the availability of medications, the treatment was switched to infliximab [1]. After 3 months, he no longer experienced gastrointestinal symptoms and demonstrated remission of tonsillar lesions (Figure 4). Histopathology with hematoxylin and eosin, demonstr-ating chronic granulomatous inflammation with multinucleated giant cells. Oroscopy after tonsilitis resolution. Although Crohn's disease can affect any region from the mouth to the anus, oral involvement occurs in 0.5%–37% of cases [2, 3]. Therefore, it is important to exclude neoplasms and opportunistic infections [3-5]. Most patients are asymptomatic, and oral manifestations may appear before or concomitantly with intestinal symptoms, and there is no agreement in always performing upper gastrointestinal endoscopy in these cases [3, 5]. The most common oral lesions in Crohn's disease include mucogingivitis, angular cheilitis, serpiginous and linear ulcers, and cobblestone-like mucous membranes [2, 3]. There are few reports in the literature describing tonsillitis related to Crohn's disease, and the most commonly used medications are azathioprine, infliximab, adalimumab and ustekinumab [1-5]. The authors contributed with the research, writing, and revising of the article. Luiz Roberto Kotze, Aryadne Marques and Nathalia I. Crosewski were also part of the patient care team. Approval was obtained after the patient signed the informed consent and the approval from the local research ethics committee by the number 78711524.3.0000.0096. The authors declare no conflicts of interest. This article has no material from other sources. The data that support the findings of this study are available from the corresponding author upon reasonable request.