Clitoral metastasis of anal adenocarcinoma associated with rectovaginal fistula in long standing Crohn's disease.

摘要

Dear Editor, An enlarged clitoris in the setting of a rectovaginal fistula in long standing Crohn's disease is an important clinical feature. In this clinical scenario, the development of anal cancer should be considered. A 45-year-old Caucasian female presented with the complaint of an enlarging clitoris. Her medical history was significant for a 23-year history of Crohn's disease with prominent perianal involvement including multiple fistulous tracts. The patient required numerous drug regimens throughout the course of her illness, consisting of mesalamine, sulfasalzine, infliximab, azothioprine, 6-mercaptopurine, methotrexate, prednisone, various anti-diarrheal agents and long term antibiotic therapy with metronidazole and ciprofloxacin. Complications of her Crohn's disease included ileocecal resection and right proximal colectomy 17 years ago secondary to a perforated abscess and a small bowel resection 8 years ago.