scholarly journals Spontaneous Resolution of Enterocutaneous Fistula After Disseminated Tuberculosis Treatment in a Patient With Crohn’s Disease: Challenges in Biologic Therapy

2019 ◽  
Author(s):  
J C Silva ◽  
A Rodrigues ◽  
J Carvalho
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Biologic Therapy ◽  
Enterocutaneous Fistula ◽  
Spontaneous Resolution ◽  
Tuberculosis Treatment ◽  
Disseminated Tuberculosis

scholarly journals CMV Ileitis: To Treat or Not to Treat? Implications of Initiating Biologic Therapy for Concurrent Crohn’s Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Kendra T. Stilwell ◽  
Jason Estes ◽  
Maria T. Kurtz ◽  
James M. Francis ◽  
David T. Lynch ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Mortality Rate ◽  
Crohn's Disease ◽  
Medical Literature ◽  
Biologic Therapy ◽  
Antiviral Treatment ◽  
Current Medical ◽  
Spontaneous Resolution ◽  
Cmv Infection ◽  
Current Guidelines

Cytomegalovirus (CMV) enteritis is traditionally thought to be a self-limited infection in immunocompetent individuals. Consequently, current guidelines recommend against treating nonimmunocompromised patients with antiviral therapy. Conversely, recent data suggests that spontaneous resolution occurs less frequently than previously believed; furthermore, mortality rate in immunocompetent individuals is similar to that of the immunosuppressed. We present a case of a 43-year-old male who was simultaneously diagnosed with CMV ileitis and Crohn’s Disease. When discovered concomitantly, there is no guidance in the current medical literature regarding the benefit of antiviral treatment of the CMV infection prior to initiating biologic therapy versus the risks of withholding treatment, as is currently recommended for nonimmunosuppressed individuals.

A NOVEL APPROACH TO THE ENDOSCOPIC REPAIR OF AN ENTEROCUTANEOUS FISTULA IN A PATIENT WITH CROHN’S DISEASE

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S48-S48
Author(s):  
Cortney McKay ◽  
Patrick Brown ◽  
Jason Schairer
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Surgical Resection ◽  
Biologic Therapy ◽  
Enterocutaneous Fistula ◽  
Argon Plasma Coagulation ◽  
Fistulous Tract ◽  
Surrounding Tissue ◽  
Treatment Modalities ◽  
Patient Reported

Abstract Introduction Enterocutaneous fistula (ECF) is an abnormal connection that develops anywhere between the gastrointestinal tract and the skin. Fistulae most commonly occur in the context of inflammatory bowel disease. Standard definitive management involves surgery and biologic therapy. We present a case of an ECF treated with endoscopic and medical management. Case Presentation A 34-year-old man with Crohn’s disease with prior colectomy and ileorectal anastomosis presented with abdominal pain. CT enterography demonstrated a fistulous tract from the bowel to the anterior abdominal wall concerning for ECF. He subsequently underwent sigmoidoscopy with confirmation of ECF on the ileal side of his anastomosis. He was started on metronidazole 500 mg three times a day, azathioprine at 175 mg daily, and adalimumab 40 mg every other week in attempts to close the fistulous tract, however the patient reported continued drainage. Surgical correction was offered. However, in attempts to avoid surgical resection, he underwent sigmoidoscopy, where the tract was identified. A cytology brush was introduced into the fistula and used to irritate the epithelial layer to promote scarring. Next, doxycycline was injected through a scleroneedle into the track as a sclerosing agent. Argon plasma coagulation (APC) of the fistula internal os and surrounding tissue was performed, followed by deployment of 2 hemoclips to promote closure of the internal os. Initially there was closure but 2 months later there was recurrence of ECF. Sigmoidoscopy was repeated with administration of doxycycline to sclerose the tract, followed by APC to the tissue adjacent to the internal os, and the placement of a hemoclip to oppose the tissue around the internal os. Following endoscopic treatment, the patient’s ECF has remained healed. Since ECF closure, he has been in endoscopic and clinical remission for over 4 years. Discussion This approach was successful in the treatment of ECF. Doxycycline has been used for treatment of recurrent pleural effusions, lymphatic malformations and lymphoceles due to its sclerosing properties. Mechanism of action is unknown, but it is believed to be due to the induction of an inflammatory reaction that results in fibrosis and ablation of endothelial-lined cavities. APC has been used in the treatment of gastrointestinal conditions, including angiodysplasias and colonic polyps post polypectomy. There is limited evidence discussing its effectiveness of endoscopic fistulous repairs. Our experience reviews that the combination of biologic therapy and endoscopic therapeutic options are a successful option in the treatment of ECF. While surgical resection remains a treatment option, patient’s typically favor less invasive strategies. Further studies should investigate endoscopic closure of fistulous tracts in order to provide more treatment modalities to our patients.

A Case of Crohn's Disease Diagnosed from a Subcutaneous Abscess Caused by Enterocutaneous Fistula

2015 ◽  
Vol 77 (2) ◽  
pp. 128-130
Author(s):  
Toshikazu OMODAKA ◽  
Koichi HAYASHI ◽  
Fuminao KAMIJO ◽  
Atsuko OHASHI ◽  
Tomomi MIYAKE ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enterocutaneous Fistula

P084 DEEP REMISSION WITH DOUBLE BIOLOGIC THERAPY: A SUCCESSFUL CASE OF COMBINATION USTEKINUMAB AND VEDOLIZUMAB FOR SEVERE REFRACTORY CROHN’S DISEASE

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S72-S72
Author(s):  
Ahmed Elmoursi ◽  
Courtney Perry ◽  
Terrence Barrett
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Clinical Remission ◽  
Biologic Therapy ◽  
Case Reports ◽  
Sigmoid Resection ◽  
Safety And Efficacy ◽  
Ileal Stricture

Abstract Background Stricturing Crohn’s disease (CD) constitutes a severe phenotype often associated with a high degree of morbidity (3). Surgical resection is first-line therapy for symptomatic strictures, but most patients relapse without subsequent medical therapy (4–5). Biologics are the mainstay for inducing and maintaining remission, but some cases are refractory despite maximum dosage of therapy. Reports of dual biological therapy (DBT) in refractory, stricturing CD are sparse, and prior case reports document only clinical remission (1). To contribute further knowledge regarding the use of DBT in stricturing CD, we present the case of a refractory CD patient who achieved deep remission with ustekinumab and vedolizumab. Case Presentation A 35 year old non-smoking, Caucasian male was referred to our clinic in 2014 for refractory CD complicated by multiple strictures. Prior to establishing care with us, he received two jejunal resections and a sigmoid resection. Previously failed therapies included azathioprine with infliximab, adalimumab, and certolizumab. He continued to progress under our care despite combination methotrexate/certolizumab, as well as methotrexate/golimumab. He underwent proctocolectomy with end ileostomy in 2015 and initiated vedolizumab q8weeks post-operatively. He reoccurred in 2018, when he presented with an ulcerated ileal stricture. He was switched from vedolizumab to ustekinumab q8weeks and placed on prednisone, but continued to progress, developing significant hematochezia requiring hospitalization and blood transfusions. Ileoscopy performed during hospital admission confirmed severe, ulcerating disease in the ileum with stricture. Ustekinumab dosing was increased to q4weeks, azathioprine was initiated, and he underwent stricturoplasty. Follow-up ileoscopy three months later revealed two ulcers in the neo- TI (Figure 1). Vedolizumab q8weeks was initiated in addition to ustekinumab q4weeks and azathioprine 125mg. After four months on this regimen the patient felt better, but follow-up ileoscopy showed two persistent ulcers in the neo-TI. Vedolizumab dosing interval was increased to q4weeks. After four months, subsequent ileoscopy demonstrated normal neo-TI (Figure 2). Histologic evaluation of biopsies confirmed deep remission of crohn’s disease. No adverse side effects have occurred with maximum doses of both ustekinumab and vedolizumab combination therapy. Discussion This case supports both the safety and efficacy of ustekinumab and vedolizumab dual biologic therapy for treatment of severe, refractory Crohn’s disease. While there are reports of DBT inducing clinical remission, this case supports efficacy for vedolizumab and ustekinumab combination therapy to induce deep histologic remission. Large practical clinical trials are needed to better investigate the safety and efficacy of DBT with vedolizumab and ustekinumab, but our case suggests this combination may be a safe and efficacious therapy for refractory CD patients.

T1305 Are Anti-TNFS Able to Close Enterocutaneous Fistula in Crohn's Disease?

2010 ◽  
Vol 138 (5) ◽  
pp. S-533
Author(s):  
Setakhr Vida ◽  
Philippe Seksik ◽  
Treton Xavier ◽  
Matthieu Allez ◽  
Martine De Vos ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enterocutaneous Fistula

scholarly journals A Case of Disseminated Tuberculosis in a Child with Crohn's Disease After Treatment with Azathioprine, Adalimumab and Ustekinumab

2021 ◽  
Vol 57 (8) ◽  
pp. 552-554
Author(s):  
Marie Catherine Renoux ◽  
Sarah Dutronc ◽  
Laura Kollen ◽  
Sarah Theret ◽  
Johan Moreau
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disseminated Tuberculosis

Enterocutaneous fistula in severely active Crohn’s disease: preoperative anti-TNF alpha treatment to limit bowel resection—report of a case

2018 ◽  
Vol 34 (2) ◽  
pp. 369-373 ◽  
Author(s):  
Peter Wilhelm ◽  
Andreas Kirschniak ◽  
Jonas Johannink ◽  
Sascha Kaufmann ◽  
Thomas Klag ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Resection ◽  
Enterocutaneous Fistula ◽  
Tnf Alpha
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