Introduction: Crohn`s disease (CD) is a chronic relapsing inflammatory bowel disease (IBD). It is characterized by a transmural granulomatous inflammation which can affect any part of the gastrointestinal tract. CD most commonly affects the ileum, colon or both. Despite biological treatment being associated with an improved health-related quality of life, patients still report impediment on daily activities during both flares and remissions.
Materials and Methods: A case of a 41-year-old man with a history of IBD affecting pars duodeni, the small intestine and the colon (A3L3B2) is presented. Manifestations related to the disease such as abdominal pain and diarrhea appeared in 2015.Virtual colonoscopy and the biopsy from the ascending and transverse colon indicated typical development for Crohn`s disease. Due to the progression of CD, a therapy with Adalimumab (HUMIRA) was started. Symptoms such as coughing, sweating and subfebrile temperature appeared in 2017 - eight months after the biological treatment. The control endoscopic examinations indicated an impact on the upper gastrointestinal tract.
Results: Biological therapy with Adalimumab (HUMIRA) was started. Eight months later the patient presented with respiratory symptoms. Mantoux and Interferon-Gamma Release Assays (IGRAs) results were negative excluding latent tuberculosis (LTBI). The results of chest X-ray imaging were normal. Therapy with Esomeprazole and antihistamines was started.
Conclusion: Crohn`s disease affecting both the upper and lower gastrointestinal tract indicates progression. Biological treatment is associated with an improved health-related lifestyle and all patients who are candidates should be studied to detect a possible LTBI, given that they constitute one of the groups at highest risk of developing tuberculosis.
