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A case of fistulizing Crohn's disease and erythema nodosum managed with adalimumab

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 278–281 (2008)Cite this article

Abstract

Background A 20-year-old female presented to her gastroenterologist with fevers and right-labial pain and swelling. Painful erythematous nodules developed in her pretibial region soon after admission to a medical ward. She had a 10-year history of Crohn's colitis, perirectal abscesses and fistulizing disease, and had undergone a diverting ileostomy 16 months earlier; however, she was not on any medication for her Crohn's disease owing to her history of drug intolerance and side effects.

Investigations Physical examination, laboratory investigations, examination under anesthesia, proctoscopy, MRI, and skin biopsy.

Diagnosis Active Crohn's disease with perianal fistula and sigmoid colitis, and erythema nodosum.

Management Subcutaneous injections of adalimumab: an initial 160 mg dose, followed by 80 mg in week 2 and then 40 mg every other week. Antibiotics were also prescribed.

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Figure 1: The pretibial region of the patient before initiation of adalimumab, showing the presence of erythematous nodules and lower-extremity edema.
Figure 2: An excisional biopsy sample taken from the patient, which reveals septal granulomatous panniculitis (inflammation of the superficial fascia of the subcutaneous fat tissue).
Figure 3: The pretibial region of the patient 4 weeks after treatment with adalimumab, showing resolution of erythematous nodules and lower-extremity edema.

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Acknowledgements

The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Department of the Navy, US Department of Defense, or the US Government.

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Authors and Affiliations

  1. A Quin is a Medical Corps Staff Officer in the Department of Gastroenterology, Naval Medical Center San Diego, San Diego, CA, USA.,

    Alissa Quin

  2. S Kane is an Associate Professor of Medicine in the Division of Gastroenterology, Mayo Clinic College of Medicine, Rochester, MN.,

    Sunanda Kane

  3. O Ulitsky is a Fellow in the Section of Dermatology, University of Chicago Medical Center, Chicago, IL.,

    Olga Ulitsky

Authors
  1. Alissa Quin
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  2. Sunanda Kane
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  3. Olga Ulitsky
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Corresponding author

Correspondence to Alissa Quin.

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Competing interests

Sunanda Kane has acted as a consultant for, and received grant/research support from Abbott. The other authors declared no competing interests.

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Quin, A., Kane, S. & Ulitsky, O. A case of fistulizing Crohn's disease and erythema nodosum managed with adalimumab. Nat Rev Gastroenterol Hepatol 5, 278–281 (2008). https://doi.org/10.1038/ncpgasthep1099

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