Infliximab and surgical therapy in a patient with severe crohn’s disease: a case report

Background: The treatment with infliximab is highly effective in refractory and fistulising Crohn’s disease. As Crohn’s disease represents a major challenge for surgery and since the conservative therapeutical approach with anti-TNF antibodies always requires consideration of potential benefits and risks for the patient as well, the optimal treatment requires a close interdisciplinary approach.
Case Report: Here we describe the case of a young male with a history of rapidly manifesting Crohn’s disease(and unrecognized celiac disease) whose conflicting findings presented dilemma to use infliximab in consideration of its contraindications. After multilateral discussions with specialists and judicious revision of his results, the patient was treated successfully and minimal surgical intervention was needed instead of heroic surgery. A minority of patients with celiac disease who fail to respond to a gluten-free diet may require therapy with immunomodulating drugs. Our patient’s remission
was not induced by infliximab but with gluten-free diet.
Conclusions: A 2-year follow-up demonstrated distinct improvement. Celiac disease poses a therapeutic challenge to clinicians and carefully selected patients may benefit from anti-TNF therapy although our experience does not strengthen this concept.

Keywords: Crohn’s disease, celiac disease, Surgery, infliximab