[Corticosteroid refractory colonic Crohn disease with successful remission with infliximab].
We review the case of a 14 year old patient complaining of 5 months of bloody and mucous diarrhea, abdominal pain, fever and 10 kg weight loss. At the beginning she received cotrimoxazole and then chloramphenicol with no success. With the suspicious of tuberculosis she was treated for a month with the corresponding drugs with no clinical improvement. Colonoscopy revealed the presence of punch - like ulcers, deep linear ones cobblestoning and skip lesions. The histological analysis showed severe distortion the colonic mucosa, ulcers, granulation tissue, lymphoid follicles and a trend towards the formation of granulomatous lesions. The clinical, endoscopic and histological features were consistent with Crohn disease. The activity index for it was greater than 450. The patient received 60 mg bid hydrocortisone but switched to 20 mg bid methylprednisolone at day 10th. After 10 days and because she was doing worst refractoriness to corticoids was considered and 5 mg / kg Infliximab was started. At the third day of treatment symptoms improved dramatically and one week later was almost asymptomatic. Similar dosage of Infliximab was repeated at weeks 2, 6 and 8. Currently the patient is being treated with 75 mg azathioprine as maintenance therapy.
Departamento del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins (EsSALUD), Lima, Peru. alva.edgar@gmail.com
Edgar
E
Alva
Jorge
J
Vásquez
Oscar
O
Frisancho
Lidia
L
Mantilla
Alejandro
A
Yábar
Domingo
D
Morales
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069285:Infliximab; D012074:Remission Induction; D017211:Treatment Failure
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab