Pyostomatitis vegetans leading to Crohn’s disease diagnosis

Pyostomatitis vegetans (PV) is a rare oral condition of unknown pathogenesis, usually considered a specific marker of inflammatory bowel disease (IBD), in particular Crohn's disease [1-5]. PV manifests with yellowish, linear pustules set on an erythematous base that are usually called " snail track ulcerations " [3,4]. Hallopeau first introduce the term PV for similar skin lesions in 1898, and McCarthy described the oral analogue as PV in 1949 [6]. The presentation of PV may coincide, precede or follow intestinal involvement [6,7]. We present a rare case of PV that led to the diagnosis of Crohn's disease, in order to emphasize the association of oral and gastrointestinal (GI) diseases. A 58-year-old man was referred for evaluation of " white lesions that looked like pus " on the labial gingiva. The lesions peeled off during tooth brushing, without causing any discomfort. They had been initially diagnosed as pseudomembranous candidiassis and unsuccessfully medicated with Miconazole nitrate oral gel. The patient's medical history disclosed that during the last few months he had been suffering from bloody diarrhea. Complete colonoscopy was performed by a GI specialist, and a diagnosis of " hemorrhoids " was given. Clinical examination revealed numerous yellow-white mucosal pustules on the labial maxillary and mandibular gingiva, as well as the hard palate. They were asymptomatic, set on an erythematous base, had the characteristic appearance of " snail-tracks " , and easily peeled off upon rubbing with