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Jung, Lee, Chung, Lee, Lee, Chung, Kim, and Cho: Successful Primary Infliximab Treatment of Orofacial Crohn's Disease without Gastrointestinal Manifestation
Case Report
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 59(6): 437-440.

Published online: 20 June 2012

DOI: https://doi.org/10.4166/kjg.2012.59.6.437

Successful Primary Infliximab Treatment of Orofacial Crohn's Disease without Gastrointestinal Manifestation

Bo Yong Jung, Suck-Ho Lee, Seung Kyu Chung, Chang Kyun Lee1, Tae Hoon Lee, Il-Kwun Chung, Sun-Joo Kim, Hyun-Deuk Cho2

Department of Internal Medicine, Cheonan Hospital, Soon Chun Hyang University College of Medicine, Cheonan, Korea.

1Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.

2Department of Pathology, Cheonan Hospital, Soon Chun Hyang University College of Medicine, Cheonan, Korea.

Correspondence to: Suck-Ho Lee, Department of Gastroenterology, Cheonan Hospital, Soon Chun Hyang University College of Medicine, 31 Soonchunhyuang 6-gil, Dongnam-gu, Cheonan 330-721, Korea. Tel: +82-41-570-3664, Fax: +82-41-574-5762, ygun99@hanmail.net

Received 29 December 2010       Revised 11 February 2011       Accepted 11 February 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Crohn's disease is a chronic inflammatory bowel disease that can involve the whole gastrointestinal tract. The orofacial manifestation of Crohn's disease, which is rare, can develop irrespective of intestinal involvement. These orofacial lesions are often misdiagnosed as simple oral ulcers. Corticosteroids are the mainstay of therapy for orofacial Crohn's disease. However, infliximab, the chimeric monoclonal antibody to tumor necrosis factor-α, is now considered as a primary treatment because of the disease's relatively high rate of steroid resistance. We present a case of deep oral ulcer and periorbital swelling in a 65-year-old woman. She was diagnosed with intestinal Crohn's disease 7 years ago, which was in remission after treatment with an immunosuppressive agent (azathioprine). The patient was given the diagnosed with orofacial Crohn's disease and successfully treated with infliximab.

Keywords: Orofacial Crohn's disease, Oral ulcer, infliximab

Figures and Tables

Fig. 1
Initial orofacial manifestations. (A) Erythematous swelling on right periorbital area and upper lip were noted. (B) Deep punched-out ulcerative lesion was noted on the left tongue base.
kjg-59-437-g001
Fig. 2
Biopsy of the tongue base. It showed the stratified squamous epithelium with numerous neutrophil and lymphocytic infiltrations without definite granuloma (H&E, ×200).
kjg-59-437-g002
Fig. 3
Serial improvements after infliximab infusion. After infliximab treatment, facial (A) lesion was much improved. Four weeks after infliximab treatment, oral (B) lesions had completely disappeared.
kjg-59-437-g003
Table 1
Summary of Response to Infliximab Therapy in Patients with Orofacial Crohn's Disease
kjg-59-437-i001

Notes

Financial support: None.

Conflict of interest: None.

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