Onset of severe perianal disease in Crohn's disease under treatment with infliximab: successful treatment with adalimumab and setons drainage.

摘要

Tumor necrosis factor alpha (TNF-alpha) is a key proinflammatory cytokine involved in the pathogenesis of inflammatory bowel disease (IBD), as shown by using infliximab, a chimeric anti-TNF-alpha monoclonal antibody, in treating patients affected by severe IBD. Flare or onset of IBD in association with immunosuppression has been reported in the literature, and flare of IBD under treatment with anti-TNF-alpha antibodies due to loss of response may occur. Here we present the case of an 18-year-old female patient with a diagnosis of ileal nonstricturing-nonpene-trating Crohn's disease (CD) since 2006. In August 2006 she experienced diarrhea, abdominal pain, and weight loss (10 kg in 3 months); a gastros-copy showed erosions of the second duodenal portion and a colonoscopy showed aphtoid ulcers in the terminal ileum.