Treatment of severe esophageal Crohn's disease with infliximab

Esophageal ulceration with fistula is an uncommon manifestation of Crohn's disease. Typical presentation of symptomatic esophageal Crohn's disease may include dysphagia, odynophagia, weight loss, and chest discomfort. We pres ent a patient with severe esophageal and skin involvement of Crohn's diseas e that was progressive despite conventional therapy including prednisone an d 6-mercaptopurine. The diagnosis of Crohn's was based on the presence of t ypical clinical, endoscopic, and pathologic findings, including granulomas in the skin ulcer and the absence of infectious etiologies. The patient had a nearly complete resolution of her esophageal disease with a single infus ion of infliximab.