Oral features of Crohn's disease include ulcers, lip fissuring, cobblestone 
plaques, angular cheilitis, polypoid lesions, and perioral erythema. 
Pyostomatitis vegetans is a rare eruption of the oral mucosa characterized by 
tiny yellow pustules. It is considered a marker for inflammatory bowel disease. 
We describe a 45-year-old woman with a 6-month history of painful sores in her 
mouth, diarrhea, weight loss, and cutaneous lesions. Oral examination revealed 
cobblestone plaques and indentation on the tongue and friable vegetating 
pustules on the labial commissures. Staphylococcus simulans was isolated from 
the pustules. Laboratory studies revealed leucocytosis, eosinophilia, and low 
hemoglobin and zinc levels. Histologic study of the labial lesions revealed 
hyperplastic epithelium with intraepithelial clefts that contain eosinophils and 
neutrophils. Tongue lesions showed chronic inflammation with noncaseating 
granulomas. Later, colonoscopy and biopsy demonstrated Crohn's disease of the 
anorectal region. Pyostomatitis vegetans lesions regressed after oral zinc 
supplementation. Prednisone treatment resulted in healing of the tongue lesions. 
In our patient, pyostomatitis vegetans appeared to be related to zinc deficiency 
that may have been caused by malabsorption. The pathogenetic interrelationship 
between pyostomatitis vegetans and Crohn's disease is discussed.