Coexisting crohn's disease and takayasu's arteritis in two patients treated with anti-TNF-α therapies

S. Ratuapli, M. Mazlumzadeh, S. Gurudu, S. Money, R. Heigh

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Crohn's disease (CD) and Takayasu's arteritis (TA) are inflammatory granulomatous autoimmune disorders. Simultaneous occurrence of CD and TA in the same individual is rare. We report two cases treated with biologic agents. Case 1: A 16-year-old male presented with abdominal pain, nausea, vomiting. CT angiogram showed thickening of the terminal ileum, wall thickening and narrowing of multiple large and medium arteries including aorta and left common carotid. Colonoscopy with biopsy of the stenotic ileocecal valve confirmed CD. Resected carotid artery pathology was consistent with TA. Treatment was initially begun with prednisone, then methotrexate was started followed by infliximab. Due to side effects, methotrexate was switched to azathioprine. He remained asymptomatic. Case 2: A 38-year-old male with well-characterized Crohn's ileocolitis for 15 years, who had been treated with prednisone, mesalamine, sulfasalazine, and azathioprine presented with chest, upper back and abdominal pain. CT angiogram showed vasculitis of large and medium arteries, with stenosis of the right renal artery, and wall thickening of the sigmoid colon. He was diagnosed with TA. He underwent treatment with infliximab and adalumimab on different occasions, which were later discontinued due to fever, bacteremia and complications from sepsis. He remained on prednisone and azathioprine. In these two patients with both CD and TA the diagnoses were confirmed by imaging and pathologic findings. Both patients developed vascular complications. Tumor necrosis factor inhibitor therapy was effective in one patient but discontinued in the other due to infection. Further research into the association of CD and TA may provide clues to their etiologies and guide effective interventions.

Original languageEnglish (US)
Pages (from-to)35-40
Number of pages6
JournalCase Reports in Gastroenterology
Volume4
Issue number1
DOIs
StatePublished - 2010

Fingerprint

Takayasu Arteritis
Crohn Disease
Azathioprine
Prednisone
Methotrexate
Abdominal Pain
Angiography
Therapeutics
Arteries
Ileocecal Valve
Mesalamine
Sulfasalazine
Renal Artery Obstruction
Biological Factors
Sigmoid Colon
Colonoscopy
Back Pain
Bacteremia
Vasculitis
Ileum

Keywords

  • Anti-TNF alpha
  • Coexisting
  • Crohn's disease
  • Takayasu's arteritis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Coexisting crohn's disease and takayasu's arteritis in two patients treated with anti-TNF-α therapies. / Ratuapli, S.; Mazlumzadeh, M.; Gurudu, S.; Money, S.; Heigh, R.

In: Case Reports in Gastroenterology, Vol. 4, No. 1, 2010, p. 35-40.

Research output: Contribution to journalArticle

Ratuapli, S. ; Mazlumzadeh, M. ; Gurudu, S. ; Money, S. ; Heigh, R. / Coexisting crohn's disease and takayasu's arteritis in two patients treated with anti-TNF-α therapies. In: Case Reports in Gastroenterology. 2010 ; Vol. 4, No. 1. pp. 35-40.
@article{bab426a55ca04f6abe6dd561fa8e31dd,
title = "Coexisting crohn's disease and takayasu's arteritis in two patients treated with anti-TNF-α therapies",
abstract = "Crohn's disease (CD) and Takayasu's arteritis (TA) are inflammatory granulomatous autoimmune disorders. Simultaneous occurrence of CD and TA in the same individual is rare. We report two cases treated with biologic agents. Case 1: A 16-year-old male presented with abdominal pain, nausea, vomiting. CT angiogram showed thickening of the terminal ileum, wall thickening and narrowing of multiple large and medium arteries including aorta and left common carotid. Colonoscopy with biopsy of the stenotic ileocecal valve confirmed CD. Resected carotid artery pathology was consistent with TA. Treatment was initially begun with prednisone, then methotrexate was started followed by infliximab. Due to side effects, methotrexate was switched to azathioprine. He remained asymptomatic. Case 2: A 38-year-old male with well-characterized Crohn's ileocolitis for 15 years, who had been treated with prednisone, mesalamine, sulfasalazine, and azathioprine presented with chest, upper back and abdominal pain. CT angiogram showed vasculitis of large and medium arteries, with stenosis of the right renal artery, and wall thickening of the sigmoid colon. He was diagnosed with TA. He underwent treatment with infliximab and adalumimab on different occasions, which were later discontinued due to fever, bacteremia and complications from sepsis. He remained on prednisone and azathioprine. In these two patients with both CD and TA the diagnoses were confirmed by imaging and pathologic findings. Both patients developed vascular complications. Tumor necrosis factor inhibitor therapy was effective in one patient but discontinued in the other due to infection. Further research into the association of CD and TA may provide clues to their etiologies and guide effective interventions.",
keywords = "Anti-TNF alpha, Coexisting, Crohn's disease, Takayasu's arteritis",
author = "S. Ratuapli and M. Mazlumzadeh and S. Gurudu and S. Money and R. Heigh",
year = "2010",
doi = "10.1159/000270919",
language = "English (US)",
volume = "4",
pages = "35--40",
journal = "Case Reports in Gastroenterology",
issn = "1662-0631",
publisher = "S. Karger AG",
number = "1",

}

TY - JOUR

T1 - Coexisting crohn's disease and takayasu's arteritis in two patients treated with anti-TNF-α therapies

AU - Ratuapli, S.

AU - Mazlumzadeh, M.

AU - Gurudu, S.

AU - Money, S.

AU - Heigh, R.

PY - 2010

Y1 - 2010

N2 - Crohn's disease (CD) and Takayasu's arteritis (TA) are inflammatory granulomatous autoimmune disorders. Simultaneous occurrence of CD and TA in the same individual is rare. We report two cases treated with biologic agents. Case 1: A 16-year-old male presented with abdominal pain, nausea, vomiting. CT angiogram showed thickening of the terminal ileum, wall thickening and narrowing of multiple large and medium arteries including aorta and left common carotid. Colonoscopy with biopsy of the stenotic ileocecal valve confirmed CD. Resected carotid artery pathology was consistent with TA. Treatment was initially begun with prednisone, then methotrexate was started followed by infliximab. Due to side effects, methotrexate was switched to azathioprine. He remained asymptomatic. Case 2: A 38-year-old male with well-characterized Crohn's ileocolitis for 15 years, who had been treated with prednisone, mesalamine, sulfasalazine, and azathioprine presented with chest, upper back and abdominal pain. CT angiogram showed vasculitis of large and medium arteries, with stenosis of the right renal artery, and wall thickening of the sigmoid colon. He was diagnosed with TA. He underwent treatment with infliximab and adalumimab on different occasions, which were later discontinued due to fever, bacteremia and complications from sepsis. He remained on prednisone and azathioprine. In these two patients with both CD and TA the diagnoses were confirmed by imaging and pathologic findings. Both patients developed vascular complications. Tumor necrosis factor inhibitor therapy was effective in one patient but discontinued in the other due to infection. Further research into the association of CD and TA may provide clues to their etiologies and guide effective interventions.

AB - Crohn's disease (CD) and Takayasu's arteritis (TA) are inflammatory granulomatous autoimmune disorders. Simultaneous occurrence of CD and TA in the same individual is rare. We report two cases treated with biologic agents. Case 1: A 16-year-old male presented with abdominal pain, nausea, vomiting. CT angiogram showed thickening of the terminal ileum, wall thickening and narrowing of multiple large and medium arteries including aorta and left common carotid. Colonoscopy with biopsy of the stenotic ileocecal valve confirmed CD. Resected carotid artery pathology was consistent with TA. Treatment was initially begun with prednisone, then methotrexate was started followed by infliximab. Due to side effects, methotrexate was switched to azathioprine. He remained asymptomatic. Case 2: A 38-year-old male with well-characterized Crohn's ileocolitis for 15 years, who had been treated with prednisone, mesalamine, sulfasalazine, and azathioprine presented with chest, upper back and abdominal pain. CT angiogram showed vasculitis of large and medium arteries, with stenosis of the right renal artery, and wall thickening of the sigmoid colon. He was diagnosed with TA. He underwent treatment with infliximab and adalumimab on different occasions, which were later discontinued due to fever, bacteremia and complications from sepsis. He remained on prednisone and azathioprine. In these two patients with both CD and TA the diagnoses were confirmed by imaging and pathologic findings. Both patients developed vascular complications. Tumor necrosis factor inhibitor therapy was effective in one patient but discontinued in the other due to infection. Further research into the association of CD and TA may provide clues to their etiologies and guide effective interventions.

KW - Anti-TNF alpha

KW - Coexisting

KW - Crohn's disease

KW - Takayasu's arteritis

UR - http://www.scopus.com/inward/record.url?scp=77958548738&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77958548738&partnerID=8YFLogxK

U2 - 10.1159/000270919

DO - 10.1159/000270919

M3 - Article

AN - SCOPUS:77958548738

VL - 4

SP - 35

EP - 40

JO - Case Reports in Gastroenterology

JF - Case Reports in Gastroenterology

SN - 1662-0631

IS - 1

ER -