title: Treatment of therapy-resistant perineal metastatic Crohn's disease after proctectomy using anti-tumor necrosis factor chimeric monoclonal antibody, cA2: report of two cases.
abstract: OBJECTIVE
  Two young females with well-documented Crohn's disease and nonhealing perineal wounds following proctectomy compatible with "metastatic Crohn's disease" are described. We hypothesized that metastatic Crohn's disease would be a tumor necrosis factor-dependent inflammatory reaction and have treated these two patients with the anti-tumor necrosis factor chimeric monoclonal antibody, cA2.
  
  
  RESULTS
  Administration of cA2 was followed by a rapid reduction of subjective and objective parameters of inflammation and caused a substantial reduction of the wound size.
  
  
  CONCLUSIONS
  These preliminary data are consistent with a tumor necrosis factor-dependent inflammatory cause of Crohn's disease and its extraintestinal manifestations and provide support for targeting tumor necrosis factor in this condition.
authors.affiliation: Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: van Dullemen
authors.forename: E
authors.initials: E
authors.lastname: de Jong
authors.forename: F
authors.initials: F
authors.lastname: Slors
authors.forename: G N
authors.initials: GN
authors.lastname: Tytgat
authors.forename: S J
authors.initials: SJ
authors.lastname: van Deventer
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001706:Biopsy; D002097:C-Reactive Protein / Q000032:analysis; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D010502:Perineum / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*
chemical_list: D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein