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Published on: September 20, 2018
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Behçet's disease-induced massive small intestinal bleeding successfully treated with adalimumab.
1Department of Education, China Medical University Hospital, Taichung, Taiwan.
Journal of Postgraduate Medicine
|June 26, 2023
Summary
This case study highlights adalimumab as an effective treatment for severe gastrointestinal bleeding caused by Behçet's disease. The biologic therapy successfully halted bleeding from intestinal ulcers, demonstrating its therapeutic potential in managing this rare condition.
Area of Science:
- Gastroenterology
- Rheumatology
- Immunology
Background:
- Behçet's disease is a rare multisystemic inflammatory disorder.
- Gastrointestinal involvement in Behçet's disease can lead to severe, life-threatening hemorrhage.
- Conventional treatments may not always be sufficient for managing acute gastrointestinal bleeding in Behçet's disease.
Observation:
- A 27-year-old female presented with generalized skin rashes, followed by massive bloody stools and hypovolemic shock.
- Initial investigations including CT-angiography and esophagogastroduodenoscopy failed to identify the bleeding source.
- Ileocolonoscopy revealed multiple large, deep ulcers in the terminal ileum with active bleeding.
Findings:
- Endoscopic interventions (epinephrine injection, hemoclips) were unsuccessful in controlling the massive intestinal bleeding.
- Subcutaneous administration of adalimumab (a TNF-alpha inhibitor) was initiated.
- Adalimumab therapy led to the cessation of gastrointestinal bleeding within days and ulcer healing observed via capsule endoscopy.
Implications:
- Adalimumab represents a promising therapeutic option for managing severe gastrointestinal bleeding in Behçet's disease.
- Early consideration of biologic therapy may prevent complications associated with uncontrolled hemorrhage.
- This case underscores the importance of timely diagnosis and multidisciplinary management for Behçet's disease with gastrointestinal manifestations.
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