Long-Term Partial Remission of AutoImmune Thrombocytopenia in a Patient Treated with the Anti-Tumor Necrosis Factor-Alpha Antibody Infliximab for Refractory Fistulizing Crohn’s Disease

Abstract

Background: Up to the present date, the treatment of recurrent chronic fistulas occurring with Crohn’s disease represents a challenging task for both internists and surgeons alike. Methods: Conservative methods of treatment using steroids, dietotherapy, antibiotics or immunosuppressive agents are not particularly effective in treating fistulas. Treatment with anti-tumor necrosis factor-α (TNFα) antibodies results in more remissions of fistulas. However, its use requires appropriate medical experience and causes substantial costs. Surgical procedures such as fistula sanitation or protective ileostomy are often obfuscated by the recurrence of the condition. The efficiency of anti-TNFα antibodies for the treatment of active Crohn’s disease has been evidenced through several multicenter, double-blind, placebo-controlled studies. Results: Here we report the successful anti-TNFα treatment of a patient suffering from chronic, fistulizing, therapy-resistant Crohn‘s disease and a concomitant chronic autoimmune thrombocytopenia. The chimeric anti-TNFα antibody infliximab markedly reduced the disease activity of Crohn’s disease, and, in addition, substantially increased the platelet counts. After infliximab application, no other treatment of autoimmune thrombocytopenia was required. After infliximab therapy, autoantibodies to dsDNS could be observed. However, there were no signs of a lupus-like disease. Conclusion: This report indicates a favorable therapeutic response of autoimmune thrombocytopenia associated to Crohn’s disease.

Association of Immune Thrombocytopenia and Inflammatory Bowel Disease in Children

“…From what has been previously published, no indication about the possible efficacy of any ITP therapy on IBD and vice versa can be drawn: analyzing our data, no IBD therapy other than steroids, in agreement to other previous reports [ 19 ], showed any clear impact on ITP and vice versa. Infliximab, a drug that showed conflicting but frequently good results on platelet count [ 6 , 29 , 35 , 36 , 37 , 38 , 39 ], was administered in 4 patients of our cohort but did not have any impact on ITP course. With regard to colectomy, whose efficacy on platelet count is often but not always found [ 1 , 12 , 22 , 26 , 27 , 32 , 40 , 41 , 42 ], it resulted in complete recovery from ITP in both of the 2 surgically treated patients of our series, but one of them exhibited an early ITP relapse only 4 weeks after colectomy: on this basis, in our opinion, it seems impossible to predict whether colectomy may have a definitive curative role in both ITP and IBD.…”

Concomitant Immune Thrombocytopenic Purpura and Crohn’s Disease

“…Moreover, T h 1 responses may mediate both acute ITP and CD [21]. As discussed above, remission was achieved in two cases concomitant ITP and CD following the administration of infliximab (anti-TNF-alpha antibodies) [21,34].…”

“…The main clinical characteristics of the 17 reported cases of concomitant ITP and CD [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] are summarized in Table 1. An association between ITP and CD was first reported by Kosmo et al [27] in 1986 in a review of the English language literature, although the first report in the Japanese language literature was by Kimura et al [26] in 1983.…”

“…Potential mechanisms of action of anti-TNF-alpha therapies include apoptotic and cytotoxic effects on monocytes and macrophages (the major producers of soluble TNF-alpha) and subsequent decreases in antiplatelet antibody production by B lymphocytes [2,21]. De Rossi et al [34] proposed the use of anti-TNF-alpha antibodies as an efficient and relatively costefficient treatment in cases of ITP, particularly when concomitant with CD. Infliximab may be considered in patients refractory to standard therapies for concomitant CD and ITP [2,34,35].…”

“…De Rossi et al [34] proposed the use of anti-TNF-alpha antibodies as an efficient and relatively costefficient treatment in cases of ITP, particularly when concomitant with CD. Infliximab may be considered in patients refractory to standard therapies for concomitant CD and ITP [2,34,35].…”