Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 14, 2022; 10(2): 733-740
Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.733
Accelerated Infliximab Induction for Severe Lower Gastrointestinal Bleeding in a Young Patient with Crohn’s Disease: A Case Report
Jing Zeng, Feng Shen, Jian-Gao Fan, Wen-Song Ge
Jing Zeng, Feng Shen, Jian-Gao Fan, Wen-Song Ge, Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Author contributions: Zeng J, Shen F, and Ge WS were the patient’s attending physician, reviewed the literature and contributed to manuscript drafting; Fan JG and Ge WS were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by National Natural Science Foundation of China, No. 81873565 and No. 82100605; SJTU Trans-med Awards Research, No. 20190104; Star Program of Shanghai Jiaotong University, No. YG2021QN54.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Song Ge, PhD, Chief Doctor, Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China. gewensong@xinhuamed.com.cn
Received: August 19, 2021
Peer-review started: August 19, 2021
First decision: October 16, 2021
Revised: October 23, 2021
Accepted: December 7, 2021
Article in press: December 7, 2021
Published online: January 14, 2022
Processing time: 145 Days and 4.7 Hours
Abstract
BACKGROUND

Severe lower gastrointestinal bleeding (SLGIB) is a rare complication of Crohn's disease (CD). The treatment of these patients is a clinical challenge. Monoclonal anti-TNFα antibody (IFX) can induce relatively fast mucosal healing. It has been reported for the treatment of SLGIB, but there are few reports on accelerated IFX induction in CD patients with SLGIB.

CASE SUMMARY

A 16-year-old boy with a history of recurrent oral ulcers for nearly 1 year presented to the Gastroenterology Department of our hospital complaining of recurrent periumbilical pain for more than 1 mo and having bloody stool 4 times within 2 wk. Colonoscopy showed multiple areas of inflammation of the colon and a sigmoid colon ulcer with active bleeding. Hemostasis was immediately performed under endoscopy. The physical examination of the patient showed scattered small ulcers in the lower lip of the mouth and small cracks in the perianal area. Combined with his medical history, physical examination, laboratory examinations with high C-reactive protein (CRP), platelet count (PLT), erythrocyte sedimentation rate (ESR) and fecal calprotectin levels, imaging examinations and pathology, a diagnosis of CD was taken into consideration. According to the pediatric CD activity index 47.5, methylprednisolone (40 mg QD) was given intravenously. The abdominal pain disappeared, and CRP, PLT, and ESR levels decreased significantly after the treatment. Unfortunately, he had a large amount of bloody stool again after 1 wk of methylprednisolone treatment, and his hemoglobin level decreased quickly. Although infliximab (IFX) (5 mg/kg) was given as a combination therapy regimen, he still had bloody stool with his hemoglobin level decreasing from 112 g/L to 80 g/L in a short time, so-called SLGIB. With informed consent, accelerated IFX (5 mg/kg) induction was given 7 days after initial presentation. The bleeding then stopped. Eight weeks after the treatment, repeat colonoscopy showed mucosal healing; thus far, no recurrent bleeding has occurred, and the patient is symptom-free.

CONCLUSION

This case highlights the importance of accelerated IFX induction in SLGIB secondary to CD, especially after steroid hormone treatment.

Keywords: Crohn’s disease; Severe lower gastrointestinal bleeding; Steroid hormone; Accelerated infliximab induction; Case report

Core Tip: Severe lower gastrointestinal bleeding (SLGIB) is a rare complication of Crohn's disease (CD) that is potentially life-threatening. The treatment of these patients is a clinical challenge. Monoclonal anti-TNFα antibody infliximab (IFX) can induce relatively fast mucosal healing. It has been reported for the treatment of SLGIB, but there are few reports on accelerated IFX induction in CD patients with SLGIB. We present a patient with CD complicated with SLGIB. The bleeding was finally controlled, and colonoscopy showed mucosal healing after accelerated IFX induction.