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Biological treatment of Crohn`s disease

Dzhanan Sherif, Maria Penkova, Nuster Shiho, Timur Kyashif, Meral Halil


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.


Crohn`s disease; biological treatment; latent tuberculosis



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