title: Oral ulcerations are associated with the loss of response to infliximab in Crohn's disease.
abstract: We describe a 25-year-old Caucasian man with a 13-year history of inflammatory Crohn's disease (CD) who was suffering recurrent severe oral and esophageal ulcerations for the past 3 years. His CD had been treated with infliximab infusions among other medications. The loss of efficacy was confirmed by antibodies to infliximab (ATI) and serum infliximab tests that showed high levels of ATIs and undetectable levels of infliximab respectively. These findings were consistent with significant immunogenic response to infliximab leading to loss of effect. Infliximab infusions and prednisone were discontinued and treatment of the CD was instituted with adalimumab, a human anti-tumor necrosis factor (TNF)-alpha biologic agent, to control the inflammatory small intestinal disease and dapsone for the oral and esophageal CD ulcerations. The patient's oral and esophageal lesions as well as the enteric CD are under control after 5 months of therapy.
authors.affiliation: Division of Periodontics, Department of Dental Specialties, Mayo Clinic, Mayo Building, Rochester, MN 55905, USA. sanchez.andres@mayo.edu
authors.forename: A R
authors.initials: AR
authors.lastname: Sánchez
authors.forename: R S
authors.initials: RS
authors.lastname: Rogers
authors.forename: P J
authors.initials: PJ
authors.lastname: Sheridan
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000276:immunology / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000276:immunology / Q000627:therapeutic use*; D004361:Drug Tolerance; D004935:Esophageal Diseases / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D000069285:Infliximab; D008297:Male; D019226:Oral Ulcer / Q000188:drug therapy* / Q000209:etiology; D014456:Ulcer / Q000188:drug therapy / Q000209:etiology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents; D000069285:Infliximab; D000068879:Adalimumab