Published online Apr 15, 2021. doi: 10.4251/wjgo.v13.i4.305
Peer-review started: October 22, 2020
First decision: January 7, 2021
Revised: January 16, 2021
Accepted: March 7, 2021
Article in press: March 7, 2021
Published online: April 15, 2021
Processing time: 168 Days and 18 Hours
Crohn's disease (CD) causes a range of digestive symptoms including recurrent diarrhea, abdominalgia, and flatulence, and severely impacts the quality of life of patients. Infliximab, a monoclonal antibody against tumor necrosis factor alpha, has recently been promoted as a therapeutic treatment for CD, but its safety margins remain uncertain. We report a case of rapidly progressive colorectal cancer that was diagnosed in a patient with CD who had previously been treated with infliximab.
This case report refers to a 40-year-old male with a 6-year history of CD. The patient underwent transverse colostomy because of inflammatory ileus in 2017. He subsequently received infliximab treatment in 2018. Ten months later, worsening contracture of the transverse colostomy was observed. Imaging tests indicated that the patient may have developed colon cancer with extensive peritoneal implantation. At the same time, colonoscopy revealed a rectal mass and pathological examination indicated well-differentiated adenocarcinoma. Palliative ileostomy was performed to improve defecation in 2019. During the operation, a small nodular mass in the mesentery of the small intestine was identified and pathological examination of the mass revealed advanced adenocarcinoma. The patient was diagnosed with advanced colorectal cancer and administered palliative chemotherapy. He died in June 2020.
We stress the importance of recognizing the possible occurrence of malignance in patients with CD receiving infliximab.
Core Tip: Crohn’s disease can result in diffuse intestinal lesions, including intestinal edema, stenosis, and even mucosal bleeding, which makes pathological diagnosis difficult. Although tumor necrosis factor alpha inhibitors are efficacious for inflammatory bowel disease, they may contribute to malignancy in particularly susceptible individuals. This case demonstrates that when a patient is receiving long-term treatment with infliximab, it is important to monitor for the development of neoplasia. When neoplasia is found, surgical resection must be performed in time to prevent tumor progression and spread.