Recalcitrant Vulval and Perineal Crohn Disease Responding to Hyperbaric Oxygen Therapy

V ulval and perineal disease is a recognized manifestation of Crohn disease (CD). Extensive disease can be profoundly symptomatic, functionally disabling, and psychologically distressing. Medical options remain the mainstay of treatment; however, refractory cases can be therapeutically challenging. We report a patient with progressive refractory perineal CD (PCD) and vulval CD (VCD) who had failed systemic corticosteroids, antibiotics, mercaptopurine, infliximab and adalimumab, with a good clinical outcome to hyperbaric oxygen therapy (HBOT). Although HBOT can be effective in wound healing and PCD, its role in the management of VCD has not been well described. In our patient, surgical options were not appropriate, and alternate biological agents were unavailable. Given the severity of the condition, the significant impact on quality of life, and limited treatment options, HBOTwas administered. Clinical improvement was sustained for 6 months, and a further course of HBOT was required with good effect. Consent for data and image usage for the purpose of publication was granted by the patient.