Smells like M. Crohn: Two Case Reports of Nasal Manifestations of Crohn’s Disease

Abstract Introduction Crohn’s disease is a chronic inflammatory bowel disease that can extend beyond the gastrointestinal tract, affecting organs such as the skin, joints, eyes, liver, and biliary tract. Nasal involvement is exceedingly rare, with only a limited number of cases reported in the literature. Case presentation In the first case, a 45-year-old woman presented with recurrent epistaxis, nasal crusting, and spontaneous septal perforation, accompanied by gastrointestinal and systemic symptoms. After extensive evaluation excluded alternative causes, ileocolonoscopy and histopathology supported a diagnosis of mild Crohn’s disease with nasal involvement as an extraintestinal manifestation. Systemic treatment ultimately resulted in remission of gastrointestinal symptoms and stabilization of the nasal disease. The second case involved a 53-year-old woman with longstanding Crohn’s disease who developed persistent rhinorrhea and extensive inflammatory lesions of the nasal cavity and nasopharynx despite intestinal remission. Histopathology demonstrated chronic inflammation without granulomas. Initial corticosteroid and azathioprine therapy was insufficient, whereas escalation to adalimumab resulted in complete resolution of the upper airway abnormalities and sustained clinical remission. Conclusion These cases illustrate that nasal and nasopharyngeal involvement can occur as a rare extraintestinal manifestation of Crohn’s disease, either at initial presentation or independently of active intestinal disease, and may respond well to systemic immunosuppressive or biological therapy. Awareness of this rare manifestation is essential, as early recognition may minimize diagnostic delay, prevent long-term complications, and enable timely initiation of appropriate immunosuppressive therapy.