Korean J Gastroenterol.  2012 Jun;59(6):437-440. 10.4166/kjg.2012.59.6.437.

Successful Primary Infliximab Treatment of Orofacial Crohn's Disease without Gastrointestinal Manifestation

Affiliations
  • 1Department of Internal Medicine, Cheonan Hospital, Soon Chun Hyang University College of Medicine, Cheonan, Korea. ygun99@hanmail.net
  • 2Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
  • 3Department of Pathology, Cheonan Hospital, Soon Chun Hyang University College of Medicine, Cheonan, Korea.

Abstract

Crohn's disease is a chronic inflammatory bowel disease that can involve the whole gastrointestinal tract. The orofacial manifestation of Crohn's disease, which is rare, can develop irrespective of intestinal involvement. These orofacial lesions are often misdiagnosed as simple oral ulcers. Corticosteroids are the mainstay of therapy for orofacial Crohn's disease. However, infliximab, the chimeric monoclonal antibody to tumor necrosis factor-alpha, is now considered as a primary treatment because of the disease's relatively high rate of steroid resistance. We present a case of deep oral ulcer and periorbital swelling in a 65-year-old woman. She was diagnosed with intestinal Crohn's disease 7 years ago, which was in remission after treatment with an immunosuppressive agent (azathioprine). The patient was given the diagnosed with orofacial Crohn's disease and successfully treated with infliximab.

Keyword

Orofacial Crohn's disease; Oral ulcer, infliximab

MeSH Terms

6-Mercaptopurine/analogs & derivatives/therapeutic use
Aged
Anti-Inflammatory Agents/*therapeutic use
Antibodies, Monoclonal/*therapeutic use
Crohn Disease/diagnosis/*drug therapy
Female
Gastrointestinal Diseases/pathology
Humans
Immunosuppressive Agents/therapeutic use
Oral Ulcer/diagnosis

Figure

  • Fig. 1 Initial orofacial manifestations. (A) Erythematous swelling on right periorbital area and upper lip were noted. (B) Deep punched-out ulcerative lesion was noted on the left tongue base.

  • Fig. 2 Biopsy of the tongue base. It showed the stratified squamous epithelium with numerous neutrophil and lymphocytic infiltrations without definite granuloma (H&E, ×200).

  • Fig. 3 Serial improvements after infliximab infusion. After infliximab treatment, facial (A) lesion was much improved. Four weeks after infliximab treatment, oral (B) lesions had completely disappeared.


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