Successful treatment of oral Crohn's disease by anti-TNF-alpha dose escalation - a case report
- Arne Bokemeyer†1,
- Nicolas Tentrop†2,
- Peter J. Barth3,
- Frank Lenze1,
- Karin Hengst1,
- Johannes Kleinheinz2 and
- Dominik Bettenworth1Email author
© The Author(s). 2018
- Received: 12 September 2017
- Accepted: 5 June 2018
- Published: 18 June 2018
Crohn’s Disease (CD) is typically characterized by abdominal symptoms, however, besides gastrointestinal symptoms, CD patients may suffer from extraintestinal manifestations which are far less common and medical treatment can be challenging.
We report about a 34-year-old Crohn’s Disease (CD) patient in clinical remission under adalimumab therapy who presented in the clinic for Cranio-Maxillo Surgery due to severe pain in the mandibular area. Ulcerative lesions of the buccal-side mucosa of the right mandible were detected. To rule out malignancy, a biopsy was obtained and revealed ulcerative stomatitis with noncaseating granulomas consistent with oral CD. Shortening the adalimumab administration interval to weekly injections resulted in a complete healing of the oral CD lesions without residual inflammation.
The case presented here demonstrates that gastroenterologists should evaluate and consider oral CD lesions as a possible marker of disease activity in patients despite having quiescent intestinal CD.
- Inflammatory bowel disease
- Crohn’s disease
- Immunosuppressive therapy
Inflammatory bowel disease (IBD), including Crohn’s disease (CD), are frequent inflammatory disorders of the gastrointestinal tract . Patients with a flare-up of disease frequently present with inflammation-associated symptoms like abdominal pain, diarrhea and fever . Besides frequent gastrointestinal symptoms, extraintestinal manifestations of CD are far less common in these patients and medical treatment can be challenging.
While CD commonly manifests in the intestine of affected patients, oral lesions like aphthous ulcers or stomatitis are rare and occur only in approximately 10% of patients . A recently published systematic review on oral CD manifestations in pediatric patient cohorts indicates that oral lesions can develop coincidently with gastrointestinal inflammation or even precede and thus may represent the initial sign of another disease flare . Medical treatment of these oral lesions can be challenging and published evidence on medical treatment efficacy for oral CD lesions is limited . Besides a few case reports, a most recently published study by Vavricka et al. documents a response rate of 78% for anti-TNF treatment in 32 adult IBD patients with oral disease manifestations [5, 6]. Additionally, our case presented here, demonstrates that anti-TNF therapy intensification can also represent a successful treatment approach in CD patients with oral disease lesions. Therapeutic drug monitoring was not available at the time the patient was treated at our institution, but is nowadays widely spread and can facilitate clinical decision making in IBD patients with primary or secondary loss of response towards anti-TNF treatment.
Concluding, oral lesions are a rare manifestation of CD and gastroenterologists should consider these lesions as a possible marker of disease activity in patients despite having quiescent intestinal CD.
We thank our patient for letting us share our experience with our colleagues.
Availability of data and materials
All data and material are available in the electronical chart record at the University Hospital Münster.
AB, NT, and DB treated the patient and wrote the manuscript; FL and PB treated the patient and contributed writing the manuscript; KH and JK contributed writing the manuscript. All authors have read and approved the manuscript.
Ethics approval and consent to participate
Consent for publication
We obtained a written informed consent of the patient prior to submission.
The authors declare that they have no competing interests.
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