Mustafa YAKUT, Gülnihan KIRBAŞ, Hakan BOZKAYA

Gastroduodenal tutulumu olan, infliksimab tedavisi ile anaflaktik reaksiyon gelişen kronik fistülizan Crohn hastalığı olgusu

Uzun süredir ileokolonik Crohn hastalığı ile takip edilen 54 yaşındaki kadın hasta karın ağrısı ve kilo kaybı şikayetleri ile kliniğimize kabul edildi. 26 ay önce Crohn hastalığına bağlı gelişen obstrüksiyon nedeni ile opere olmuş sonrasında gelişen enterokütan fistül nedeni ile diversiyon kolostomisi açılmış. Hastamızın üst gastrointestinal endoskopik incelemesi Crohn hastalığı ile uyumluydu. Endoskopik incelemede korpus ve antrumda mukozal ödem, diffuz eritem, nodüler lezyonlar, ülser, erozyonlar ve kaldırım taşı görünümü gözlendi. Üst gastrointestinal sistem endoskopik biyopsilerinin histopatolojik incelemesinde kronik lenfoplazmositer iltihap ve granülom izlendi. Hasta şimdiye kadar birçok tedavi almıştı ve hastayı kabul ettiğimizde günlük 150 mg azotiopürin tedavisi alıyordu. Hastalığın kontrolü için infliksimab tedavisi başlandı. İkinci dozda infliksimaba bağlı gelişen hipersensitivite reaksiyonu nedeni ile infliksimab tedavisi kesilip gastrik ve fistülizan Crohn hastalığı'nda etkili adalimumab tedavisi başlandı. Gastrik Crohn hastalığı nadirdir ve olguların çoğu ileokolik Crohn hastalığı'na eşlik eder. Üst gastrointestinal sistem Crohn hastalığı'nda endoskopik bulgular distal Crohn hastalığı ile benzerdir. Crohn hastalığı hastalarının 1/3'ünde fistüller gelişir. Fistulizan Crohn hastalığı'nda indüksiyon ve idamede infliksimab tedavisi günümüzde altın standarttır. Adalimumab tedavisi de gastrik ve fistülizan Crohn hastalığı'nda etkili ve güvenilirdir.

Anahtar Kelimeler:

Gastroduodenal Crohn hastalığı, fistülizan Crohn hastaliğı, infliksimab tedavisi

Report of infliximab therapy in gastroduodenal and fistulizing Crohn disease

A 54-year-old female with long-standing ileocolic Crohn's disease was admitted to the hospital with abdominal pain and weight loss. The patient underwent surgery because of obstructive syndrome and had undergone a diverting ileostomy 26 months earlier. She had enterocutaneous fistulizing disease. In our case, there were endoscopic lesions, including mucosal edema, focal and diffuse erythema, nodular lesions, erosion, and ulcers in the antrum and corpus with a paving-stone appearance. Upper endoscopy was suspicious for gastric Crohn involvement. Multiple endoscopic biopsies of the stomach showed granuloma and chronic lymphoplasmacytic inflammation. She had been treated with multiple therapies during that time, including azathioprine 75 mg given daily. Infliximab therapy was initiated to control the patient's underlying Crohn's disease. We stopped infliximab treatment because of side effects, which included hypersensitivity reactions, and then started adalimumab, which is an effective and safe treatment for the induction and maintenance of response in gastric and fistulizing Crohn's disease. Crohn's disease of the stomach is rare. There is nearly always concomitant disease in the small bowel or colon. Endoscopic findings of proximal Crohn's disease resemble those of distal Crohn's disease. Fistulae will develop in approximately one-third of patients with Crohn's disease. The current gold standard of medical treatment to induce and maintain remission for fistulizing Crohn's disease is infliximab. Adalimumab is an effective and safe treatment for the induction and maintenance of response in luminal and perianal fistulizing Crohn's disease.

Keywords:

Crohn involvement, enterocutaneous fistulizing disease, infliximab therapy,

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