Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 14, 2009; 15(18): 2293-2295
Published online May 14, 2009. doi: 10.3748/wjg.15.2293
Successful use of adalimumab for treating fistulizing Crohn’s disease with pyoderma gangrenosum: Two birds with one stone
Eva Zold, Arpad Nagy, Katalin Devenyi, Margit Zeher, Zsolt Barta
Eva Zold, Arpad Nagy, Margit Zeher, Zsolt Barta, Division of Clinical Immunology, 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Debrecen 4004, Hungary
Katalin Devenyi, Euromedic Diagnostics Szeged Kft, Debrecen 4004, Hungary
Author contributions: All authors gave substantial contributions to acquisition, analysis and interpretation of data; Zeher M drafted the manuscript; Barta Z gave final approval of the version to be published.
Correspondence to: Eva Zold, MD, Division of Clinical Immunology, 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4004, Hungary. zold_eva@yahoo.com
Telephone: +36-52-255218
Fax: +36-52-255218
Received: February 10, 2009
Revised: March 30, 2009
Accepted: April 6, 2009
Published online: May 14, 2009
Abstract

Crohn’s disease (CD) is a chronic relapsing and remitting autoinflammatory disorder of the gastrointestinal tract that has many intestinal and extraintestinal complications. The purpose of treatment is long-term remission, reduction of complications, and improvement of patients’ quality of life. In many cases, this can be quite challenging and it is necessary to have a well thought out management strategy. We present the case of a 38-year-old woman with fistulizing CD that manifested as diffuse abdominal pain and bloody diarrhea accompanied by arthralgia. In addition, there were ulcerative lesions surrounded by cutaneous inflammation and erythema on her extremities, indicative of pyoderma gangrenosum. The patient was treated with high doses of parenteral methylprednisolone without any improvement and was started on adalimumab. A positive response to adalimumab therapy was observed: after 2 mo of therapy, the ulcerative skin lesion healed completely and the enterogastric fistula was closed after 5 mo adalimumab treatment. Adalimumab might be a suitable initial as well as maintenance therapy in patients with complicated CD.

Keywords: Adalimumab; Crohn’s disease; Pyoderma gangrenosum