Infliximab treatment of a fulminate Crohn's disease patient also presenting celiac disease symptoms. Case presentation

Abstract

Crohn's disease is a chronic, non-specific transmural colonic inflammatory disease of unknown etiology which can affect the whole gastrointestinal tract. According to recent literature, tumor necrosis factor alpha (TNF-alpha) plays an important role in the development of mucosal inflammation. Infliximab, a monoclonal TNF-alpha antibody which by binding to soluble and transmembrane TNF as well can block its effects in vivo and in vitro. The authors present the case of a young Crohn's patient in whom abdominal wall abscesses and fistula developed besides pancolitis. The disease developed fulminantly so there was no possibility to initiate classical therapy regimens. After surgical consultation decided to administer infliximab therapy (5mg/body weight on the 0.-2. and 6.th weeks). For objectification of the disease course we used the Crohn's disease activity index (CDAI or Best score). After treatment the fistula closed and the radical surgical intervention could be avoided. Gluten sensitive enteropathy (GSE) also could be proven in this patient (based on histology and antibodies) but the symptomatology of this disease did not change despite infliximab therapy without diet. After it the recommended gluten free diet made the patient symptom free. Coexistence of these two diseases is rarity in the literature so attention should be paid to Crohn's patients who are not symptom free after specific treatment. On the other hand, infliximab therapy may not useful for the treatment of celiac disease.