title: [Management of colonic Crohn disease with no response to corticoids and sulfazalazine: first case of pediatric use of infliximab in Peru].
abstract: We present the first Peruvian pediatric case of induction of remission and maintenance of Crohn's disease with infliximab.
  
  
  METHODS
  9-year old female who presented with perianal fistulas, intermittent diarrhea and poor weight gain since 8 months of age. Due to lack of improvement with medical therapy she had a colostomy at 4 years of age. A surgical biopsy showed chronic colitis with inflammation extending to the muscularis mucosae, with areas of glandular atrophy. A diagnosis of Crohn's disease was made. She received prednisone, sulfasalazine and antibiotics without significant improvement. She became undernourished, stunted, and anemic. Consequently, at 8 years of age we started infliximab, 100 mg per doses (5.5 mg/kg/doses). After 4 infusions her perianal fistulas closed. However, after 8 months of treatment she had a disease exacerbation with abdominal pain and diarrhea. Therefore, we added azathioprine (2 mg/kg/d PO) and shortened maintenance infliximab infusions from every 8 to every 4 weeks. Gastrointestinal symptoms resolved. So far the patient has had no adverse events secondary to therapy.
  
  
  CONCLUSIONS
  This patient has a rare early onset and aggressive form of Crohn's disease that responded to infliximab, who needed the addition of azathioprine to maintain remission.
authors.affiliation: Unidad de Gastropediatría, Servicio de Pediatría Especializada, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú.
authors.forename: Ana
authors.initials: A
authors.lastname: Muñoz Urribarri
authors.forename: Francisco
authors.initials: F
authors.lastname: Sylvester
authors.forename: Alex
authors.initials: A
authors.lastname: Delgado Godos
authors.forename: Raúl
authors.initials: R
authors.lastname: Castillo Durán
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069285:Infliximab; D010568:Peru; D012460:Sulfasalazine / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D012460:Sulfasalazine; D000069285:Infliximab