Severe Crohn's Disease in Combination with Undifferentiated Autoimmune Liver Disease - A Case Report

Sergey Semenovich Gaiduk; Mikhail Ivanovich Gromov; Alexey Viktorovich Kosachev; Ludmila Pavlovna Pivovarova

doi:doi:10.11648/j.wjmcr.20210201.13

| Peer-Reviewed

Severe Crohn's Disease in Combination with Undifferentiated Autoimmune Liver Disease - A Case Report

Sergey Semenovich Gaiduk, Mikhail Ivanovich Gromov, Alexey Viktorovich Kosachev, Ludmila Pavlovna Pivovarova

Published in World Journal of Medical Case Reports (Volume 2, Issue 1)

Received: 27 January 2021 Accepted: 6 February 2021 Published: 23 February 2021

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Crohn’s disease is a chronic autoimmune pathology of intestinal mucosa in the form of segmentary lesions of various parts with the development of transmural granulomatous inflammation and the formation of strictures, stenosis, fistulas, as well as damage to other organs. The disease tends to be developed mainly in young people. Over recent years anti-TNF mAb has been widely used in the treatment of Crohn’s disease. Case Report: from the age of 13 Patient A suffered from Crohn’s disease, weight deficit, muscular atrophy. At the age of 19, autoimmune hepatitis with developing cirrhosis joined. At the age of 22 there was another disease exacerbation. The efficiency of treatment with steroids, aminosalicylates and cytostatics was low. After replacing cytostatics with anti-TNF mAb, the patient’s condition became even worse: body weight, total protein, albumin, hemoglobin and coagulation indices decreased critically. A treatment in intensive care and multiple blood transfusions were required for the period of 1 year. Changes in the treatment strategy in the form of maintaining the therapy with steroids and aminosalicylates, withdrawing anti-TNF mAb and adding the plasma exchange and injection of native DNA (sodium deoxyribonucleate) led to an increase in body weight, total protein and hemoglobin to normal values, as well as improved bowel function and performance status. Under condition of sever Crohn’s disease with autoimmune hepatitis, the catabolic effects of the anti-TNF mAb can be extremely dangerous. In such a case, it is preferable to use steroids and aminosalicylates in combination with plasma exchange and reparation activators (e.g., native DNA).

Published in	World Journal of Medical Case Reports (Volume 2, Issue 1)
DOI	10.11648/j.wjmcr.20210201.13
Page(s)	7-10
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Crohn's Disease, Monoclonal Antibodies, TNF-α, Anemia, DNA, Sodium Deoxyribonucleate, Plasma Exchange

References

[1]	Adler G. Morbus Crohn Colitis ulcerosa. Spriger-Verlad, 1993. doi: 10.1007/978-3-642-97440-3.
[2]	Sinenchenko G. I., Peregudov S. I., Tulupov A. N. Endolymphatic drug therapy of acute inflammatory diseases in emergency abdominal surgery [Ehndolimfaticheskaya lekarstvennaya terapiya ostryh vospalitelnyh zabolevanij v neotlozhnoj abdominalnoj hirurgii]. SPb.: DMITRIJ BULANIN, 2014. [Rus].
[3]	Gomes C. A., Podda M., Veiga S. C., Cabral T. V., Lima L. V., Miron L. C., Oliveira V. L., Aranha G. L. Management of inflammatory bowel diseases in urgent and emergency scenario. J. Coloproctol. (Rio J.) 2020 Jan/Mar; 40 (1). doi: 10.1016/j.jcol.2019.10.012 Epub 2020 Mar 23.
[4]	Belousova E. A. Ulcerative colitis and Crohn's disease [Yazvennyj kolit i bolezn Krona]. M.: “Triada”. 2002. [Rus].
[5]	Safi M. H., Li J. Non-alcoholic fatty liver disease in inflammatory bowel diseases patients. IOSR Journal of Dental and Medical Sciences. 2019 Oct; 18 (10) Ser. 15: 09-15. doi: 10.9790/0853-1810150915.
[6]	Gromov M. I., Pivovarova L. P. Use of immunomodulator derinat in treatment of surgical patients with severe sepsis. Fundamental research. 2012; 7 (2): 289-295. [Rus]. URL: http://www.fundamental-research.ru/ru/article/view?id=30127 Epub 2020 Dec 17.
[7]	Dixon W. G., Watson K., Lunt M., Hyrich K. L., Silman A. J., Symmons D. P. M. Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum. 2006 Aug; 54 (8): 2368-76. doi: 10.1002/art.21978.
[8]	Susanna F. N. Pavesio C. A review of ocular adverse events of biological anti-TNF drugs. J Ophthalmic Inflamm Infect. 2020; 10 (11). doi: 10.1186/s12348-020-00202-6 Epub 2020 Apr 27.
[9]	Vulliemoz M., Brand S., Juillerat P., Mottet C., Ben-Horin S., Michetti P. TNF-alpha blockers in inflammatory bowel diseases: Practical Recommendations and a User’s Guide: an update. Digestion. 2020; 101 (suppl. 1): 16–26. doi: 10.1159/000506898.
[10]	Leombruno J. P., Einarson T. R., Keystone E. C. The safety of anti-tumour necrosis factor treatments in rheumatoid arthritis: meta and exposure-adjusted pooled analyses of serious adverse events. Ann Rheum Dis. 2009 Jul; 68 (7): 1136-45. doi: 10.1136/ard.2008.091025 Epub 2008 Aug 27.
[11]	Shah B., Mayer L. Current status of monoclonal antibody therapy for the treatment of inflammatory bowel disease. Expert Rev Clin Immunol. 2010 Jul; 6 (4): 607–620. doi: 10.1586/eci.10.45.
[12]	Sokolove J., Strand V., Greenberg J. D. Curtis J. R., Kavanaugh A., Kremer J. M., Anofrei A., Reed G., Calabrese L., Hooper M., Baumgartner S., Furst D. E. Risk of elevated liver enzymes associated with TNF inhibitor utilisation in patients with rheumatoid arthritis. Ann Rheum Dis. 2010 Sep; 69 (9): 1612-1617. doi: 10.1136/ard.2009.112136 Epub 2010 May 6.
[13]	Likhitsup A., Dundulis J., Ansari Sh., Patibandla S., Hutton C., Kennedy K., Helzberg J. H., Chhabra R. High prevalence of non-alcoholic fatty liver disease in patients with inflammatory bowel disease receiving anti-tumor necrosis factor therapy. Ann Gastroenterol. 2019 Sep-Oct; 32 (5): 463–468. doi: 10.20524/aog.2019.0405 Epub 2019 Jul 22.
[14]	Pivovarova L. P., Gromov M. I., Tulupov A. N., Lapshin V. N., Osipova I. V., Ariskina O. B., Nikitin A. V., Malyshev M. E., Markelova E. V. Influence of sodium desoxyribonucleate on anti-infectious protection and hematopoiesis in patients with polytrauma (randomized prospective, double-blind, placebo-controlled study). Medical Immunology. 2020; 22 (4): 729-740. [Rus]. doi: 10. 15786/1563-0625-IOS-1923.
[15]	Kaplina E. N., Vaynberg Yu. P. Derinat is a natural immunomodulator for children and adults. 3rd ed., rev. and corr. [Derinat - prirodnyy immunomodulyator dlya detey i vzroslykh. 3-ye izd., per. i ispr.]. M.: “Nauchnaya kniga”, 2007. [Rus].

Cite This Article

Plain Text BibTeX RIS

APA Style

Sergey Semenovich Gaiduk, Mikhail Ivanovich Gromov, Alexey Viktorovich Kosachev, Ludmila Pavlovna Pivovarova. (2021). Severe Crohn's Disease in Combination with Undifferentiated Autoimmune Liver Disease - A Case Report. World Journal of Medical Case Reports, 2(1), 7-10. https://doi.org/10.11648/j.wjmcr.20210201.13

Copy | Download

ACS Style

Sergey Semenovich Gaiduk; Mikhail Ivanovich Gromov; Alexey Viktorovich Kosachev; Ludmila Pavlovna Pivovarova. Severe Crohn's Disease in Combination with Undifferentiated Autoimmune Liver Disease - A Case Report. World J. Med. Case Rep. 2021, 2(1), 7-10. doi: 10.11648/j.wjmcr.20210201.13

Copy | Download

AMA Style

Sergey Semenovich Gaiduk, Mikhail Ivanovich Gromov, Alexey Viktorovich Kosachev, Ludmila Pavlovna Pivovarova. Severe Crohn's Disease in Combination with Undifferentiated Autoimmune Liver Disease - A Case Report. World J Med Case Rep. 2021;2(1):7-10. doi: 10.11648/j.wjmcr.20210201.13

Copy | Download

@article{10.11648/j.wjmcr.20210201.13,
  author = {Sergey Semenovich Gaiduk and Mikhail Ivanovich Gromov and Alexey Viktorovich Kosachev and Ludmila Pavlovna Pivovarova},
  title = {Severe Crohn's Disease in Combination with Undifferentiated Autoimmune Liver Disease - A Case Report},
  journal = {World Journal of Medical Case Reports},
  volume = {2},
  number = {1},
  pages = {7-10},
  doi = {10.11648/j.wjmcr.20210201.13},
  url = {https://doi.org/10.11648/j.wjmcr.20210201.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjmcr.20210201.13},
  abstract = {Crohn’s disease is a chronic autoimmune pathology of intestinal mucosa in the form of segmentary lesions of various parts with the development of transmural granulomatous inflammation and the formation of strictures, stenosis, fistulas, as well as damage to other organs. The disease tends to be developed mainly in young people. Over recent years anti-TNF mAb has been widely used in the treatment of Crohn’s disease. Case Report: from the age of 13 Patient A suffered from Crohn’s disease, weight deficit, muscular atrophy. At the age of 19, autoimmune hepatitis with developing cirrhosis joined. At the age of 22 there was another disease exacerbation. The efficiency of treatment with steroids, aminosalicylates and cytostatics was low. After replacing cytostatics with anti-TNF mAb, the patient’s condition became even worse: body weight, total protein, albumin, hemoglobin and coagulation indices decreased critically. A treatment in intensive care and multiple blood transfusions were required for the period of 1 year. Changes in the treatment strategy in the form of maintaining the therapy with steroids and aminosalicylates, withdrawing anti-TNF mAb and adding the plasma exchange and injection of native DNA (sodium deoxyribonucleate) led to an increase in body weight, total protein and hemoglobin to normal values, as well as improved bowel function and performance status. Under condition of sever Crohn’s disease with autoimmune hepatitis, the catabolic effects of the anti-TNF mAb can be extremely dangerous. In such a case, it is preferable to use steroids and aminosalicylates in combination with plasma exchange and reparation activators (e.g., native DNA).},
 year = {2021}
}

Copy | Download

TY - JOUR
T1 - Severe Crohn's Disease in Combination with Undifferentiated Autoimmune Liver Disease - A Case Report
AU - Sergey Semenovich Gaiduk
AU - Mikhail Ivanovich Gromov
AU - Alexey Viktorovich Kosachev
AU - Ludmila Pavlovna Pivovarova
Y1 - 2021/02/23
PY - 2021
N1 - https://doi.org/10.11648/j.wjmcr.20210201.13
DO - 10.11648/j.wjmcr.20210201.13
T2 - World Journal of Medical Case Reports
JF - World Journal of Medical Case Reports
JO - World Journal of Medical Case Reports
SP - 7
EP - 10
PB - Science Publishing Group
SN - 2994-726X
UR - https://doi.org/10.11648/j.wjmcr.20210201.13
AB - Crohn’s disease is a chronic autoimmune pathology of intestinal mucosa in the form of segmentary lesions of various parts with the development of transmural granulomatous inflammation and the formation of strictures, stenosis, fistulas, as well as damage to other organs. The disease tends to be developed mainly in young people. Over recent years anti-TNF mAb has been widely used in the treatment of Crohn’s disease. Case Report: from the age of 13 Patient A suffered from Crohn’s disease, weight deficit, muscular atrophy. At the age of 19, autoimmune hepatitis with developing cirrhosis joined. At the age of 22 there was another disease exacerbation. The efficiency of treatment with steroids, aminosalicylates and cytostatics was low. After replacing cytostatics with anti-TNF mAb, the patient’s condition became even worse: body weight, total protein, albumin, hemoglobin and coagulation indices decreased critically. A treatment in intensive care and multiple blood transfusions were required for the period of 1 year. Changes in the treatment strategy in the form of maintaining the therapy with steroids and aminosalicylates, withdrawing anti-TNF mAb and adding the plasma exchange and injection of native DNA (sodium deoxyribonucleate) led to an increase in body weight, total protein and hemoglobin to normal values, as well as improved bowel function and performance status. Under condition of sever Crohn’s disease with autoimmune hepatitis, the catabolic effects of the anti-TNF mAb can be extremely dangerous. In such a case, it is preferable to use steroids and aminosalicylates in combination with plasma exchange and reparation activators (e.g., native DNA).
VL - 2
IS - 1
ER -

Copy | Download

Author Information

Sergey Semenovich Gaiduk

Department of Emergency Surgery, Saint Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine”, Saint-Petersburg, Russia
Mikhail Ivanovich Gromov

Department of Efferent Therapy, Saint Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine”, Saint-Petersburg, Russia
Alexey Viktorovich Kosachev

Department of Emergency Surgery, Saint Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine”, Saint-Petersburg, Russia
Ludmila Pavlovna Pivovarova

Laboratory Diagnostics Department, Saint Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine”, Saint-Petersburg, Russia

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Sergey Semenovich Gaiduk, Mikhail Ivanovich Gromov, Alexey Viktorovich Kosachev, Ludmila Pavlovna Pivovarova. (2021). Severe Crohn's Disease in Combination with Undifferentiated Autoimmune Liver Disease - A Case Report. World Journal of Medical Case Reports, 2(1), 7-10. https://doi.org/10.11648/j.wjmcr.20210201.13

Copy | Download

ACS Style

Sergey Semenovich Gaiduk; Mikhail Ivanovich Gromov; Alexey Viktorovich Kosachev; Ludmila Pavlovna Pivovarova. Severe Crohn's Disease in Combination with Undifferentiated Autoimmune Liver Disease - A Case Report. World J. Med. Case Rep. 2021, 2(1), 7-10. doi: 10.11648/j.wjmcr.20210201.13

Copy | Download

AMA Style

Sergey Semenovich Gaiduk, Mikhail Ivanovich Gromov, Alexey Viktorovich Kosachev, Ludmila Pavlovna Pivovarova. Severe Crohn's Disease in Combination with Undifferentiated Autoimmune Liver Disease - A Case Report. World J Med Case Rep. 2021;2(1):7-10. doi: 10.11648/j.wjmcr.20210201.13

Copy | Download

@article{10.11648/j.wjmcr.20210201.13,
  author = {Sergey Semenovich Gaiduk and Mikhail Ivanovich Gromov and Alexey Viktorovich Kosachev and Ludmila Pavlovna Pivovarova},
  title = {Severe Crohn's Disease in Combination with Undifferentiated Autoimmune Liver Disease - A Case Report},
  journal = {World Journal of Medical Case Reports},
  volume = {2},
  number = {1},
  pages = {7-10},
  doi = {10.11648/j.wjmcr.20210201.13},
  url = {https://doi.org/10.11648/j.wjmcr.20210201.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjmcr.20210201.13},
  abstract = {Crohn’s disease is a chronic autoimmune pathology of intestinal mucosa in the form of segmentary lesions of various parts with the development of transmural granulomatous inflammation and the formation of strictures, stenosis, fistulas, as well as damage to other organs. The disease tends to be developed mainly in young people. Over recent years anti-TNF mAb has been widely used in the treatment of Crohn’s disease. Case Report: from the age of 13 Patient A suffered from Crohn’s disease, weight deficit, muscular atrophy. At the age of 19, autoimmune hepatitis with developing cirrhosis joined. At the age of 22 there was another disease exacerbation. The efficiency of treatment with steroids, aminosalicylates and cytostatics was low. After replacing cytostatics with anti-TNF mAb, the patient’s condition became even worse: body weight, total protein, albumin, hemoglobin and coagulation indices decreased critically. A treatment in intensive care and multiple blood transfusions were required for the period of 1 year. Changes in the treatment strategy in the form of maintaining the therapy with steroids and aminosalicylates, withdrawing anti-TNF mAb and adding the plasma exchange and injection of native DNA (sodium deoxyribonucleate) led to an increase in body weight, total protein and hemoglobin to normal values, as well as improved bowel function and performance status. Under condition of sever Crohn’s disease with autoimmune hepatitis, the catabolic effects of the anti-TNF mAb can be extremely dangerous. In such a case, it is preferable to use steroids and aminosalicylates in combination with plasma exchange and reparation activators (e.g., native DNA).},
 year = {2021}
}

Copy | Download