# Case Report: Recurrent vulvar abscess as the initial manifestation of Crohn’s disease in an adolescent

## TL;DR

A 16-year-old girl with recurring vulvar abscesses was diagnosed with Crohn's disease, highlighting the need for early IBD screening in atypical cases.

## Contribution

This case report presents a rare instance of Crohn’s disease initially manifesting as vulvar abscesses in an adolescent.

## Key findings

- Recurrent vulvar abscesses in adolescents may indicate underlying Crohn’s disease.
- Combining fecal calprotectin testing and imaging can aid in early IBD diagnosis.
- Multidisciplinary treatment with EEN and ustekinumab achieved remission without steroids.

## Abstract

Vulvar abscess as the primary and sole manifestation of Crohn’s disease (CD) is extremely rare, particularly in adolescents lacking typical gastrointestinal symptoms. This atypical presentation frequently leads to misdiagnosis and delayed treatment.

We report the case of a 16-year-old female admitted for recurrent vulvar abscesses accompanied by high fever. Initial management involved local drainage and antibiotics, but efficacy was limited. Upon admission, targeted history taking revealed a change in bowel habits. Laboratory results indicated a significant inflammatory response and positive fecal calprotectin. Combined with imaging, endoscopy, and pathology, the patient was diagnosed with ileal CD. A multidisciplinary treatment strategy was adopted. This included standardized drainage, necessary antibiotic coverage, and exclusive enteral nutrition (EEN) combined with ustekinumab to achieve steroid-free induction. The patient achieved both clinical and mucosal remission.

This case highlights that recurrent vulvar abscesses in adolescents warrant a high index of suspicion for CD. Clinicians must prioritize targeted history taking. Furthermore, fecal calprotectin testing and imaging should be combined to identify potential inflammatory bowel disease (IBD) early, thereby avoiding missed diagnoses and treatment delays.