In Crohn's disease, neurologic complications such as cerebrovascular accident, headache, peripheral neuropathy have been reported sporadically. The pathogenesis of these neurologic complications is still unknown and controversial. We experienced a 22-year-old man, with Crohn's disease accompanied by optic neuritis. Loss of visual acuity was developed during the worsening course of enterocutaneous fistula. After high dose steroid treatment, his visual acuity and neurologic symptoms improved immediately.
Adult ; Crohn Disease/*complications/drug therapy/pathology ; Humans ; Intestinal Fistula/complications ; Male ; Optic Neuritis/*complications/diagnosis

No abstract available.
Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Crohn Disease/*complications/*drug therapy ; Female ; Humans ; Intestinal Obstruction/*etiology ; Male

AIMTo describe the reproductive outcome following intracytoplasmic sperm injection (ICSI) for male factor infertility associated with Crohn's disease and 6-mercaptopurine (6-MP) chemotherapy.

METHODSThe male partner of a couple suffered from severe Crohn's disease and received a 3-month course of 6-MP for this condition. Two spontaneous conceptions were established before 6-MP, although post-chemotherapy semen analysis found the sperm concentration to be 8,000/mL. In vitro fertilization (IVF) with ICSI and embryo transfer was performed.

RESULTSThe woman underwent an uncomplicated controlled ovarian hyperstimulation sequence using a combined rec-FSH+hMG protocol, following late luteal phase pituitary downregulation. This culminated in the retrieval of 18 oocytes, 11 of which were fertilized with ICSI. She later delivered a normal male infant without urogenital anomaly. Four nontransferred blastocysts were cryopreserved.

CONCLUSIONThis report describes the first successful birth after ICSI for severe oligozoospermia associated with Crohn's disease and 6-MP therapy. We outline salient features of Crohn's disease, 6-MP pharmacology, and their relevance to human fertility.

Adult ; Crohn Disease ; complications ; drug therapy ; Female ; Humans ; Immunosuppressive Agents ; administration & dosage ; Male ; Mercaptopurine ; administration & dosage ; Oligospermia ; complications ; therapy ; Pregnancy ; Pregnancy Outcome ; Sperm Injections, Intracytoplasmic

BACKGROUND/AIMS: The prevalence of Helicobacter pylori (H. pylori) infection has been reported to be lower in individuals with inflammatory bowel disease (IBD) in some Western countries. We investigated H. pylori infection in Korean patients with IBD and any possible associations of H. pylori infection with drug therapy for IBD and the phenotype of Crohn's disease (CD). METHODS: We studied 316 unselected patients with IBD, including 169 ulcerative colitis (UC) patients and 147 with CD, and the control group consisted of 316 age- and gender-matched healthy people who received a comprehensive medical examination for a regular checkup purpose. Infection rates of H. pylori as detected by the urea breath test were compared between the IBD patients and the controls. RESULTS: A statistically significant difference in H. pylori infection rate was noticed between the IBD patients (25.3%) and the controls (52.5%; p<0.001), and between UC (32.0%) and CD patients (17.7%; p=0.04). Among the IBD patients, the age group of <60 and individuals with a history of taking metronidazole (13.0%; p=0.038) or ciprofloxacin (6.7%; p=0.001) were found to have a meaningfully lower infection rate, but those who did not take antibiotics still showed H. pylori infection rate significantly lower than the controls (CD 22.0% vs. UC 33.8% vs. Control 52.5%, p<0.001). With an exception of age, phenotypic characteristics showed no significant relations with H. pylori infection rate in CD patients. CONCLUSIONS: Korean patients with IBD, particularly CD, were found to have a significantly lower H. pylori infection rate than the controls. This association was more evident in those <60 years old, which suggested that H. pylori infection might be deemed to lower possible risks of IBD in younger adults.
Adolescent ; Adult ; Age Factors ; Aged ; Colitis, Ulcerative/complications/diagnosis/drug therapy ; Crohn Disease/complications/diagnosis/drug therapy ; Female ; Helicobacter Infections/complications/diagnosis/*epidemiology ; *Helicobacter pylori ; Humans ; Inflammatory Bowel Diseases/*complications/diagnosis/drug therapy ; Korea ; Male ; Middle Aged ; Phenotype ; Prevalence

A psoas abscess (PA) is a rare clinical entity but is potentially serious condition which presents diagnostic and therapeutic challenges. The diagnosis is frequently delayed due to its variable and nonspecific features and occult clinical course. The delay in diagnosis and treatment of PA is the major poor prognostic factor. We describe herein a case of the sterile psoas abscess complicating Cronh's disease which presented as hip flexion contracture. A 29-year-old man, at remission stage of CD involving ileocolic segment, was admitted due to pain from hip contracture. He had no bloody diarrhea and no abdominal pain. PA was confirmed by abdominal ultrasound. PA with hip contracture was completely treated with surgical excision, irrigation, drainage, and antibiotics. PA was sterile and there was no evidence of a fistulous communication from the bowel. Once suspected, aggressive diagnostic work up and definitive operative intervention is needed.
Adult ; Crohn Disease/*complications/drug therapy ; Diagnosis, Differential ; Drainage ; Hip Contracture/complications/*diagnosis/surgery ; Humans ; Male ; Psoas Abscess/*diagnosis/etiology/ultrasonography ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Many studies on infliximab have confirmed its efficacy in the remission induction and even maintenance in refractory and fistulizing Crohn's disease. We report the treatment efficacy of infliximab in Crohn's disease and ulcerative colitis refractory to steroid treatment and the complications of infliximab treatment. METHODS: We performed infliximab administration in 5 cases (3 Crohn's disease, 2 ulcerative colitis) refractory to systemic steroid treatment and 5 cases of Crohn's disease with fistula. Patients received an intravenous infusion of infliximab at 3-5 mg/kg body weight. RESULTS: In 3 cases of refractory Crohn's patients, clinical response and remission induction were obtained in 2 (67%) and 1 cases (33%). After infusion of infliximab, the occlusion of internal fistula could be found in all 2 cases. Two out of 3 cases of anal fistula were completely healed. In two cases of refractory ulcerative colitis, one case who showed clinical manifestation of toxic megacolon had improved and avoided the colectomy, but the other case did not respond to the infusion of infliximab and underwent colon resection. CONCLUSIONS: We found that administration of infliximab is an effective alternative for refractory and fistulizing Crohn's disease but further studies are necessary for refractory ulcerative colitis.
Adolescent ; Adult ; Antibodies, Monoclonal/*therapeutic use ; Colitis, Ulcerative/complications/*drug therapy ; Crohn Disease/complications/*drug therapy ; English Abstract ; Female ; Gastrointestinal Agents/*therapeutic use ; Humans ; Intestinal Fistula/complications ; Male ; Middle Aged ; Tumor Necrosis Factor-alpha

Crohn's disease is characterized by its chronic course and transmural inflammation of gastrointestinal tract. The accompanying fibrous reaction and adhesion to adjacent viscera appears to limit the complication of free perforation. The true incidence of free bowel perforation is difficult to assess, however, the anticipated occurrence rate is 1-2% during the course of illness. Moreover, portal venous gas is also an uncommon event in the natural history of Crohn's disease. Portal venous gas occurs when intraluminal gas from the gastrointestinal tract or gas-forming bacteria enters the portal venous circulation. The finding of portal venous gas associated with Crohn's disease does not always mandate surgical intervention. We experienced a case of Crohn's disease presenting with free perforation and portal venous gas. The literatures on the cases with perforation and portal venous gas associated with Crohn's disease were reviewed.
Adult ; Colonoscopy ; Crohn Disease/complications/drug therapy/*pathology ; Diagnosis, Differential ; Embolism, Air/*diagnosis/etiology ; Humans ; Intestinal Perforation/*diagnosis/etiology ; Male ; *Portal Vein ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the efficacy of infliximab combined with surgery in the treatment of perianal fistulizing Crohn disease (CD).

METHODSClinical data of 15 patients with perianal fistulizing CD receiving infliximab combined with surgery in the Affiliated Hospital of Nanjing University of Chinese Medicine from March 2010 to June 2011 were analyzed retrospectively. One week after operation, all the patients received infliximab infusion thrice at weeks 0, 2, and 6. Crohn disease activity index (CDAI), perianal Crohn disease activity index (PDAI), body mass index (BMI), routine blood test and endoscopy were evaluated at week 0, 14. Adverse reactions and healing time were recorded.

RESULTSAt week 14, the response rate was 100% with 86.7% (13/15) complete responders. One patient had local improvement and one developed recurrent fistula. The mean healing time was 32.5 (20-45) d. Anorectal stenosis in 4 patients was significantly improved. At week 14, CDAI decreased to 114.0±90.3 from 230.5±97.5 after IFX treatment. PCDAI decreased to 2.8±3.2 from 9.9±3.4, and BMI increased to (21.5±3.0)kg/m(2) from (19.1±3.1)kg/m(2). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), platelet and neutrophil were significantly decreased from baseline (all P<0.01). Intestinal mucosa healed completely in one patient. There were no serious adverse events except hypokalemia in one patient and severe infusion reaction in another.

CONCLUSIONInfliximab combined with surgery is effective and safe for perianal fistulizing CD.

Adolescent ; Adult ; Antibodies, Monoclonal ; therapeutic use ; Combined Modality Therapy ; Crohn Disease ; complications ; drug therapy ; surgery ; Female ; Follow-Up Studies ; Humans ; Infliximab ; Male ; Rectal Fistula ; drug therapy ; etiology ; surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult

Azathioprine is frequently used for the treatment of inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Lymphomas, squamous cell carcinomas, and undifferentiated pleomorphic sarcomas have been reported among patients receiving azathioprine therapy. Herein, we report a case of pleomorphic liposarcoma of chest wall which occurred in a 44-year-old man with Crohn's disease taking azathioprine. He was diagnosed with Crohn's disease 3 years ago after suffering from abdominal pain and hematochezia for 12 years. He had been taking 50 mg of azathioprine per day for 23 months when he visited the thoracic and cardiovascular surgery clinic due to right chest palpable mass that had rapidly grown during the past 2 months. Excisional biopsy was performed and the mass was diagnosed as pleomorphic liposarcoma. Therefore, he underwent radical excision of the right chest wall mass, which measured 11.0x6.5 cm in size. He is scheduled to receive radiation therapy and chemotherapy.
Adult ; Azathioprine/*therapeutic use ; Colonoscopy ; Combined Modality Therapy ; Crohn Disease/complications/*drug therapy ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Immunosuppressive Agents/*therapeutic use ; Liposarcoma/complications/*pathology/surgery ; Male ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Tomography, X-Ray Computed

BACKGROUND/AIMS: The clinical course of patients with inflammatory bowel disease (IBD) frequently leads to the use of immunosuppressants and immunomodulators. We investigated the risk of postoperative infection in patients with IBD undergoing elective bowel surgery and whether the use of corticosteroid (CS) and/or 6-mercaptopurine/ azathioprine (6-MP/AZA) before surgery was associated with the increased risk of postoperative infection. METHODS: Patients who were diagnosed as Crohn's disease (n=25) or ulcerative colitis (n=19) and underwent elective bowel surgery between 1986 and 2005 were identified. Medical records were retrospectively analyzed including age, sex, duration of disease, indication for surgery, duration of surgery, type of surgery, type of postoperative infection, admission period, usage of CS and 6-MP/AZA, and preoperative laboratory values. There were 27 patients receiving CS alone, 6 patients receiving 6-MP/AZA alone or with CS, and 16 patients receiving neither CS nor 6-MP/AZA. RESULTS: There were 17 postoperative infections (38.6%) among IBD patients who had undergone surgery and wound infection was the most common type of infection (76.5%). In IBD patients, patients receiving CS had higher postoperative infection rate than those patients receiving neither CS nor 6-MP/AZA (p=0.039). Patients receiving CS in conjunction with 6-MP/AZA did not have significantly higher postoperative infection rate than those with CS only (p=0.415). CONCLUSIONS: Preoperative use of CS in patients with IBD is associated with the increased risk of postoperative infections. Addition of 6-MP/AZA in patients receiving CS does not increase the risk of postoperative infections.
Colitis, Ulcerative/drug therapy/*surgery ; Crohn Disease/drug therapy/*surgery ; Humans ; Immunologic Factors/*adverse effects/therapeutic use ; Immunosuppressive Agents/*adverse effects/therapeutic use ; Infection/epidemiology/*etiology ; Postoperative Complications/epidemiology/*etiology ; Retrospective Studies