SEVERE FLARE-UP AFTER LOSS OF EFFECT OF AZATHIOPRINE.
INDUCTION OF REMISSION WITH ADALIMUMAB.
ILEOSCOPIC-MRE DIAGNOSIS / FOLLOW-UP
A 22-year-old patient diagnosed with ileal CD one year ago. Maintenance treatment was provided in the form of azathioprine 2.5 mg/kg for the previous 8 months. In the last month the patient showed progressive worsening of their general condition with abdominal pain, increased stool frequency (8 per day at present time), fatigue and weight loss.
Figure 1. Ileocolonoscopy revealed ileal disease with predominant inflammatory involvement and stricture formation. Signs of inflammatory activity: edema, mucosal thickening, serpiginous ulcers, nodules. Presence of ulcerated annular strictures preventing ileoscopy from advancing.
Magnetic resonance enterography (MRE) was performed to correctly assess the extent and severity of the ileal lesions.
MRE video 1. Severe inflammatory involvement affecting 40 cm of terminal ileum, with partial luminal stenosis. MRE findings indicative of moderate-severe activity. (Utilities: MRE evaluation of activity)
Since this was a severe flare-up in a patient with a loss of response to azathioprine, the decision was taken to start therapy with adalimumab, followed by early response and complete resolution of the symptoms after one month of treatment. Endoscopic control after 6 months showed the disappearance of inflammatory activity, and adalimumab monotherapy was continued.
Figure 2. Ileoscopy, post-treatment control: mucosal healing with an ileum of adequate caliber and good peristalsis and motility. Scars are observed in the previous ulcerated stricture zone and passed without difficulty.
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