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

Behçet's disease (BD) is a multisystem immune-mediated inflammatory disorder that involves the intestine in 3%-26% of cases. Corticosteroids, 5-aminosalicylic acid derivatives, immunomodulators, and more recently thalidomide and pentoxifylline have been used to treat BD with varying degrees of success. 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 monoclonal antibody to TNF-alpha, has been demonstrated to be an effective therapy for Crohn's disease and rheumatoid arthritis, 2 other Th1-mediated disorders. We describe a patient with chronically active, steroid-dependent BD 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 (preinfusion) to 13 points by week 2, and remission was sustained despite complete withdrawal of steroids. Colonoscopy performed 10 weeks after the first infusion showed marked endoscopic and histologic improvement. This report suggests that infliximab may be an effective new therapy for gastrointestinal BD, and perhaps other manifestations of BD as well.