An ileal perforation after infliximab treatment for crohn's disease in a heart transplant patient:A case report

There is controversy over the degree of inflammatory bowel disease activity after transplant. We herein report the case of a patient who presented with an ileal perforation after infliximab treatment for Crohn's disease in a heart transplant patient under immunosuppressive therapy. A 30-year-old male with an 11-year history of Crohn's disease underwent a heart transplant. Five years after the transplant, he presented symptoms consistent with intermittent small bowel obstruction related to Crohn's disease and received infliximab therapy. Three months after the induction of the therapy, he presented with sudden intense abdominal pain and an emergent laparotomy revealed fecal panperitonitis due to a perforation of the distal ileum. The long-term usage of immunosuppressive agents, especially steroids, before the induction of infliximab may have an unfavorable effect on Crohn's disease treatment. [INTRODUCTION]The safety and efficacy of infliximab, a chimeric monoclonal immunoglobulin antibody to tumor necrosis factor, has been established in a number of controlled trials for the treatment of moderate to severe active and fistulizing Crohn's disease (CD)1,2).