Anti-tumor necrosis factor monoclonal antibody therapy for gastrointestinal Behcet's disease: A case report

Behcet's disease (BD) is a multisystem immune-mediated inflammatory disorde r that involves the intestine in 3%-26% of cases. Corticosteroids, 5-aminos alicylic acid derivatives, immunomodulators, and more recently thalidomide and pentoxifylline have been used to treat ED with varying degrees of succe ss. Tumor necrosis factor (TNF)-alpha is believed to play a pivotal role in this T helper cell type 1 (Th1)-mediated disease. Infliximab, a chimeric m onoclonal antibody to TNF-alpha, has been demonstrated to be an effective t herapy for Crohn's disease and rheumatoid arthritis, 2 other Th1-mediated d isorders. We describe a patient with chronically active, steroid-dependent ED involving the gastrointestinal tract who received 4 doses of infliximab during a 6-month period. Because most of her symptoms were gastrointestinal , the Crohn's Disease Activity Index (CDAI) was used to assess response. A rapid and dramatic improvement in both gastrointestinal and extraintestinal symptoms was observed. The CDAI score decreased from 270 points (preinfusi on) to 13 points by week 2, and remission was sustained despite complete wi thdrawal of steroids. Colonoscopy performed 10 weeks after the first Infusi on showed marked endoscopic and histologic improvement, This report suggest s that infliximab may be an effective new therapy for gastrointestinal ED, and perhaps other manifestations of ED as well.