The management of fistulizing oral Crohn's disease with infliximab

Staines, Konrad; Green, R.; Felix, David H

doi:10.1111/j.1600-0714.2007.00430.x

Cited by 13 publications

(10 citation statements)

References 8 publications

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“…For more severe or refractory orofacial CD, treatment should include systemic steroids, immunomodulators, and anti-TNF-a therapy. 42,43 In patients with colostomies or ileostomies, complications include irritant or allergic contact dermatitis and peristomal ulcers. 44 The latter condition can be caused by pressure from a poorly fitting device, fistulae to the anterior abdominal wall, peristomal pyoderma gangrenosum (PG), or infected hematomas.…”

Section: Continuous/contiguous Mucocutaneous Manifestationsmentioning

confidence: 99%

Cutaneous Manifestations in Patients With Inflammatory Bowel Diseases

Marzano

Borghi

Stadnicki

et al. 2014

Inflammatory Bowel Diseases

120

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The skin is one of the most common extraintestinal organ system affected in patients with inflammatory bowel disease (IBD), including both Crohn's disease and ulcerative colitis. The skin manifestations associated with IBD are polymorphic and can be classified into 4 categories according to their pathophysiology: (1) specific, (2) reactive, (3) associated, and (4) induced by IBD treatment. Cutaneous manifestations are regarded as specific if they share with IBD the same granulomatous histopathological pattern: perianal or metastatic Crohn's disease (commonly presenting with abscesses, fistulas or hidradenitis suppurativa-like features) is the prototype of this setting. Reactive cutaneous manifestations are different from IBD in the histopathology but have close physiopathological links: pyoderma gangrenosum, a neutrophil-mediated autoinflammatory skin disease typically manifesting as painful ulcers, is the paradigm of this group. Among the cutaneous diseases associated with IBD, the most commonly seen are erythema nodosum, a form of panniculitis most commonly involving bilateral pretibial areas, and psoriasis, a T helper 1/T helper 17-mediated erythematous squamous inflammatory disease. Finally, the number of cutaneous adverse reactions because of IBD therapies is progressively increasing. The most frequent drug-induced cutaneous manifestations are psoriasis-like, eczema-like, and lichenoid eruptions, as well as cutaneous lupus erythematosus for biologics, and nonmelanoma skin cancer, mainly basal cell and squamous cell carcinomas for thiopurines.

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Section: Continuous/contiguous Mucocutaneous Manifestationsmentioning

confidence: 99%

Cutaneous Manifestations in Patients With Inflammatory Bowel Diseases

Marzano

Borghi

Stadnicki

et al. 2014

Inflammatory Bowel Diseases

120

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“…Turchi et al illustrated the success of corticosteroid induced remission followed by mesalamine maintenance therapy with no relapse after 6 months 1. Infliximab is a chimeric monoclonal antibody against tissue necrosis factor alpha (TNF-alpha) that has an established role in the initiation13 and maintenance14 of remission in moderate to severe fistulizing and non-fistulizing Crohn’s disease 15,16. Oral Crohn’s lesions resistant to mesalamine and corticosteroid therapy have been described to respond to infliximab therapy with significant symptom improvement seen with the initial infusion 11,17.…”

Section: Discussionmentioning

confidence: 99%

Oropharyngeal Crohn’s disease

Mohamed

Schultz²,

Fedorak

2008

CEG

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Crohn’s disease is a chronic inflammatory disease that can affect any part of the gastrointestinal tract. Classically the disease has a predilection for the distal small bowel and colon and presents with dominant symptoms of abdominal pain and diarrhea. This case report describes a 38-year-old woman with Crohn’s disease who presented with odynophagia. Direct visualization of the oropharynx revealed a large serpiginous Crohn’s disease ulcer. A precipitous drop in hemoglobin prompted a series of gastroenterologic investigations that confirmed both ileal and oropharyngeal Crohn’s disease. This manuscript describes the presentation of oropharyngeal Crohn’s and reviews previous reports and management options.

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“…Heresbach et al [6] reported granuloma formation in 37% of CD patients, with 25% of patients having granulomas present at the time of diagnosis. Currently there are no evidence-based guidelines for the treatment of orofacial CD; however case reports have documented success with topical and oral steroid therapy and infliximab [7,8]. We report a case of a patient with refractory severe orofacial CD whose diagnosis was challenging due to inconclusive oral and colonic histology until late in the disease course.…”

Section: Introductionmentioning

confidence: 93%

Severe Refractory Orofacial Crohn’s Disease: Report of a Case

Quezada

Turner

Alexiev³

et al. 2008

Dig Dis Sci

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Oral involvement is common in patients with Crohn's disease (CD) and can precede intestinal symptoms, making diagnosis difficult. We report a case of severe orofacial CD. A 41-year-old woman presented with palate and tongue ulcers. Biopsies showed acute inflammation with ulcer. Colonoscopy demonstrated ascending colon ulceration. Biopsies revealed acute colitis and mild architectural distortion. Prednisone was started but the symptoms recurred with taper; steroids were resumed and infliximab (IFX) 5 mg/kg was infused. After improvement, oral pain and weight loss returned. A G tube was placed. Mercaptopurine was started at 1.5 mg/kg per day. IFX was increased to 10 mg/kg. Debridement of the oral ulcers and a skin graft to the lips was performed. Pathology from oral and facial lesions was consistent with granulation tissue and fibrosis with chronic inflammation. She was readmitted several months later for weight loss and dehydration. Abdominal pain, distension, and feculent drainage developed around the G tube. Repeat computed tomography (CT) scan demonstrated pneumatosis. Laparotomy revealed purulent drainage from a perforated segment of sigmoid colon. Histology was consistent with perforated CD. Despite ventilatory and hemodynamic support and broad-spectrum antibiotics, the patient died 1 week later. Our case highlights the difficulty in diagnosing and managing orofacial CD. In this case, medical treatment was initiated based on a high index of suspicion. CD was only confirmed after intestinal resection very late in the disease course. Treatment of orofacial CD includes topical or systemic steroids, immunomodulators, and anti-tumor necrosis factor (TNF) therapies. As our case demonstrated, patients can be refractory to therapy.

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The management of fistulizing oral Crohn's disease with infliximab

Cited by 13 publications

References 8 publications

Cutaneous Manifestations in Patients With Inflammatory Bowel Diseases

Cutaneous Manifestations in Patients With Inflammatory Bowel Diseases

Oropharyngeal Crohn’s disease

Severe Refractory Orofacial Crohn’s Disease: Report of a Case

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The management of fistulizing oral Crohn's disease with infliximab

Cited by 13 publications

References 8 publications

Cutaneous Manifestations in Patients With Inflammatory Bowel Diseases

Cutaneous Manifestations in Patients With Inflammatory Bowel Diseases

Oropharyngeal Crohn&rsquo;s disease

Severe Refractory Orofacial Crohn’s Disease: Report of a Case

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Product

Resources

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Oropharyngeal Crohn’s disease