New Therapy for Orolaryngeal Manifestations of Crohn's Disease

Abstract

Crohn's disease is a chronic inflammation that may involve the entire gastrointestinal tract, from the mouth to the anus. The most widely accepted etiologic theory involves an immunologic aberration leading to local tissue destruction. Cell-mediated immunity with increased tumor necrosis factor (TNF) production may play a role in mucosal damage. Oral and laryngeal involvement are rare manifestations of Crohn's disease that are usually treated successfully by steroids. We here report a rare case of extra-intestinal Crohn's disease resistant to steroid therapy, which was successfully treated with infliximab, a chimeric antibody directed against TNF-alpha that is the only registered agent for the treatment of Crohn's disease. The relative safety, efficacy, and efficiency of infliximab make it an alternative treatment of which otolaryngologists should be aware.

Treatment of Granulomatous Cheilitis With Infliximab

“…9 Recently, a case of Crohn disease with severe orolaryngeal involvement was reported to have been treated sucessfully with infliximab. 10 Because there is an association between Crohn disease and granulomatous cheilitis, 2 we thought that a therapeutic trial of infliximab was a rational approach in the present case. This treatment has proved successful.…”

Gingival Hyperplasia as a First Manifestation of Crohn's Disease

“…Currently, steroids appear to be the most widely used agents. The efficacy of newer agents like tacrolimus (16) and, particularly, anti-TNF drugs like infliximab (17,18) remains to be fully elucidated, and the issue of cost needs to be addressed in order to allow an optimized management of this condition. Our patient showed no improvement with sulfasalazine and experienced slight relief with hydroxychloroquine, but had a rapid and complete response to oral prednisone, without recurrence during the tapering period.…”

Review article: non‐malignant oral manifestations in inflammatory bowel diseases

“…lidocaine 2%) for pain relief . Immunosuppressive agents (tacrolimus), biological treatments and even antibiotics such as tetracycline have been also used in severe or refractory cases . The algorithm of treatment of oral CD includes topical and/or systematic therapy and surgery in selected cases (Figure ).…”