Dual-Targeted Therapy With Upadacitinib and Ustekinumab in Pediatric Refractory Perianal Crohn's Disease

Perianal Crohn's disease (pCD) is a challenging manifestation of CD. We present the case of a 17-year-old adolescent girl with severe, refractory pCD, complicated by a rectovaginal fistula, who failed multiple lines of therapy and required a temporary ileostomy. While on upadacitinib (UPA) monotherapy, she experienced a flare with magnetic resonance imaging (MRI)-confirmed perianal abscesses. The addition of ustekinumab (UST) to UPA resulted in marked improvement in clinical symptoms and radiographic resolution of perianal disease on follow-up MRI. No adverse events occurred. This case highlights dual UPA/UST therapy as a promising strategy for severe, refractory pCD in an adolescent.