title: Mucosal healing of Crohn's disease in a patient with concurrent systemic lupus erythematosus using infliximab.
abstract: We describe a patient with Crohn's disease (CD) concurrent with systemic lupus erythematosus (SLE). Continuous prednisolone and cyclosporine treatment resulted in no recurrent symptoms. However, diarrhea, vomiting, and fever occurred for approximately 3 months. A colonoscopy was then performed, which showed a discontinuous cobblestone appearance and longitudinal ulcers extending from the sigmoid colon to the descending colon and distal ileum. A biopsy revealed a noncaseating granulomatous lesion in the colonic mucosa. These findings led to a diagnosis of CD concurrent with SLE. We first attempted treatment with a full elemental diet, mesalazine, and azathioprine, in that order. However, as there was no improvement in inflammation, we started infliximab, a tumor necrosis factor-alpha inhibitor. Transanal double-balloon enteroscopy performed 4 months after starting infliximab showed mucosal healing, suggesting that infliximab was effective. There are few reports of treating patients with CD concurrent with SLE using a tumor necrosis factor-alpha inhibitor. We report our experience with a patient who had mucosal healing with infliximab and review the literature.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kagaya
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Sakamoto
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sunada
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Alan Kawarai
authors.initials: AK
authors.lastname: Lefor
authors.affiliation: Department of Integrative Pathology, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Niki
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. ireef@jichi.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
mesh_terms: D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D007413:Intestinal Mucosa / Q000473:pathology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
keywords: Crohn’s disease; Infliximab; Mucosal healing; Systemic lupus erythematosus