Is really megacolon a contraindication to infliximab in Crohn's disease?

Abstract

Toxic megacolon (TM) is a rare complication of severe ulcerative colitis (UC) and colonic Crohn's disease (CD), defined as a clinical syndrome accompanied by radiographic evidence of colonic dilatation that in many cases must be treated aggressively with surgical intervention (1). We report two cases of steroid and antibiotic-refractory fulminant Crohn's colitis, complicated by toxic megacolon, who were successfully treated with infliximab (IFX), thus avoiding surgical intervention. Although there are no well defined recommendation about the correct timing of colectomy in CD-associated TM, and despite the fact that it may be imprudent to advocate delaying surgery in favour of anti-tumor necrosis (anti-TNF) factor therapy in these cases, we think that a medical "rescue therapy" can be considered in a subset of patients with stable clinical condition during corticosteroid treatment.

• Authors: Emanuele Sinagra, Ambrogio Orlando, Sara Renna, Valeria Criscuoli, Francesco La Seta, Mirko Olivo, Marco Ciofalo, Mario Cottone
• Journal: Acta gastro-enterologica Belgica (Acta Gastroenterol Belg) Vol. 76 Issue 4 Pg. 442-4 (Dec 2013) ISSN: 1784-3227 [Print] Belgium
• PMID: 24592552 (Publication Type: Case Reports, Letter)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Antibodies, Monoclonal
• Infliximab

Topics

• Adolescent
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Antibodies, Monoclonal (therapeutic use)
• Crohn Disease (complications, drug therapy)
• Female
• Follow-Up Studies
• Humans
• Infliximab
• Megacolon, Toxic (etiology)