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Crohn Disease with Oral Ulcers — RACP Adult Medicine MCQ

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EasyGastroenterologyCrohn Disease with Oral UlcersRACP Adult Medicine

A 30-year-old man presents with painful oral aphthous ulcers, perianal fistulae, and a 3-month history of bloody diarrhoea with abdominal pain. Colonoscopy shows skip lesions with deep ulcers in the ileum and colon. Biopsies show non-caseating granulomata. Pathergy test is negative. What is the most likely diagnosis?

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Correct answer: D — Crohn disease

Oral aphthous ulcers with perianal fistulae, bloody diarrhoea, skip lesions, deep ulcers, and non-caseating granulomata on biopsy is Crohn disease. Unlike Behçet, Crohn has transmural inflammation, perianal disease, and negative pathergy. Oral ulcers occur in ~10% of Crohn patients. Treatment is based on disease severity and phenotype (inflammatory, stricturing, or penetrating).

Reference: GESA – 2024 – IBD Guidelines; ECCO 2024