CASE HISTORY #1AIBD Breakout Session

Douglas C. Wolf, M.D.

DISCLOSURES

Speakers Bureau: AbbVie, Janssen, UCBConsultant: AbbVie, Janssen, UCBResearch Support: AbbVie, Janssen, UCB

35 yo female diagnosed in 1990 with Crohn’s disease

c/o lower abdominal pain and diarrhea Crohn’s colitis treated with prednisone and 6-MP Needed multiple courses of prednisone due to

disease flares 3 Hospitalizations between 1990 and 2000 1998-2000, Recto-vaginal fistula treated

unsuccessfully with 6-MP and antibiotics

PR was referred for IBD specialist evaluation. She was offered different treatment options

including participation in the ACCENT II clinical trial.

She was randomized and rapidly gained benefit with fistula closure on infliximab vs. placebo in addition to 6-MP 50 mg a day

She completed the 54 week clinical trial in remission

In 2001, she was continued on the same therapy: infliximab 5mg/kg q 8 weeks and 6-MP 50 mg/day

She remained asymptomatic with no abdominal pain, diarrhea, bleeding, or extraintestinal manifestations.

In 2006, she developed hip pain. She saw 3 orthopedists before an MRI was ordered and this showed a pelvic mass.

Biopsy revealed non-Hodgkin’s lymphoma.

She was treated with rituximab based chemotherapy.

She responded and was disease free at 9 months.

In 2007, 6 months after completing chemotherapy, she developed slight fistula recurrence in the perianal area.

What would you do?

Initially controlled with metronidazole, but developed neuropathy,

For the past 6 years has been Crohn’s disease and fistula free on rifaximin

.

She had no active fistula or other active Crohn’s disease during her chemotherapy.

She was monitored by her Emory hematologist for 5 years and remained disease free.

In 2012, her hematologist felt there was no need for further follow up

She sees me every 6 months