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Case Report: Infliximab induced remission in a case of severe Crohns enteropathic arthropathy with pyoderma gangrenosum
Abstract
Background: The indications for anti-TNF therapy for inflammatory bowel diseases (IBD) have increased to include demonstrable mucosal healing, improvement in quality of life, and treatment of extraintestinal manifestations including arthritis, sacroiliitis and pyoderma gangrenosum (PG).
Case report: A male smoker, 27 years old, with enteropathic arthropathy on top of Crohns disease (CD) had a disease duration of 2.25 years. He had severe Crohns disease activity index (CDAI = 473) and a poor health status as assessed by the IBD questionnaire (IBDQ) of 39. He had oligoarthritis and bilateral sacroiliitis. There was limited chest expansion and lumbar spine mobility. The patient had PG on the dorsum of the right foot and mild bilateral uveitis. He was receiving sulphasalazine 2000 mg/day and low dose corticosteroids 10 mg/day and was then given cyclosporine for a month and the steroid dose elevated (60 mg/day) but with partial improvement. Cyclosporine was stopped and the patient remarkably improved after receiving, in addition to the corticosteroids, IV induction regimen of infliximab 5mg/kg at 0,2 and 6 weeks. A remission occurred (CDAI 98.5) with fading of arthritis, notable decrease in the size and severity of the PG lesion and a significant disappearance of the back stiffness with an increase in the chest expansion and lumbar spine mobility. The IBDQ significantly improved to be 159.
Conclusion: Anti-TNF such as infliximab could be considered as a promising option for treatment of severe CD patients and for those with PG.
Keywords: Crohns disease, Infliximab, Pyoderma gangrenosum
Case report: A male smoker, 27 years old, with enteropathic arthropathy on top of Crohns disease (CD) had a disease duration of 2.25 years. He had severe Crohns disease activity index (CDAI = 473) and a poor health status as assessed by the IBD questionnaire (IBDQ) of 39. He had oligoarthritis and bilateral sacroiliitis. There was limited chest expansion and lumbar spine mobility. The patient had PG on the dorsum of the right foot and mild bilateral uveitis. He was receiving sulphasalazine 2000 mg/day and low dose corticosteroids 10 mg/day and was then given cyclosporine for a month and the steroid dose elevated (60 mg/day) but with partial improvement. Cyclosporine was stopped and the patient remarkably improved after receiving, in addition to the corticosteroids, IV induction regimen of infliximab 5mg/kg at 0,2 and 6 weeks. A remission occurred (CDAI 98.5) with fading of arthritis, notable decrease in the size and severity of the PG lesion and a significant disappearance of the back stiffness with an increase in the chest expansion and lumbar spine mobility. The IBDQ significantly improved to be 159.
Conclusion: Anti-TNF such as infliximab could be considered as a promising option for treatment of severe CD patients and for those with PG.
Keywords: Crohns disease, Infliximab, Pyoderma gangrenosum
