Case 2. Crohn’s disease. Stricturing ileal location refractory to corticosteroids

 

INDUCTION OF REMISSION WITH INFLIXIMAB
ILEOSCOPIC-MRE DIAGNOSIS / FOLLOW-UP

A 13-year-old girl presented with a two-month history of episodes of abdominal pain, vomiting and altered bowel habit, alternating periods of constipation and abdominal bloating with periods of liquid diarrhea. The symptoms were accompanied by asthenia and weight loss. The laboratory test findings revealed mild ferropenic anemia with hypoalbuminemia and increased acute phase reactants (C-reactive protein, erythrocyte sedimentation rate).

 

Figure 1. Ileocolonoscopy. Ileal involvement with deep ulcers and areas of preserved mucosa, giving rise to a cobblestone appearance with partial reduction of the bowel lumen.
 

The study was completed with MRE , showing involvement of the distal 30 cm of the ileum with wall thickening, stricture and inflammatory enhancement, evidencing moderate-severe activity.

Due to of the presence of aggressivity factors at diagnosis, initial therapy consisted of combination corticosteroids and azathioprine, with an adequate initial response. On starting to reduce the corticosteroid dosage, early clinical recurrence was observed. Induction therapy with infliximab associated to azathioprine was thus decided, followed by rapid symptoms resolution and the recovery of normal daily life activities. One year later the patient remains in clinical remission.

 

Figure 2. Ileoscopic control: disappearance of the ulcerated lesions and mucosal thickening. Nodular lesions consistent with nodular hyperplasia in the ileal zone closest to the valve.
 

After treatment, MRE controls were made at 6 and 12 months, showing gradual remission of the inflammatory activity.

 
casos_1_Crohnileal_caso2_fig3
Figura 3.

 
 

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