CROHN'S DISEASE IN A FEMALE PATIENT: CASE REPORT

Case Presentation A 45-year-old woman with a history of tuberculosis, endometriosis, and stroke, diagnosed with Crohn's Disease (CD) since 1998. Previous treatments included corticosteroids, 5-aminosalicylic acid, infliximab, azathioprine, adalimumab, and 70 sessions of hyperbaric oxygen therapy. After 25 years of treatment, total proctocolectomy and terminal ileostomy were performed, with perianal complications and colon stenosis. In 2020, intravenous vedolizumab was chosen due to its selective action and safety, achieving remission of the disease. In 2024, the patient switched to the subcutaneous form of vedolizumab, presenting with occult blood in the stool, bleeding from the ileostomy, pain, and abdominal distension. Ferripoly maltose and carboxymaltose iron were administered, and an enteroradiology scan revealed segmental wall thickening of the ileum near the gallbladder with partial stenosis, as well as in the right iliac fossa with significant stenosis. The patient was returned to intravenous vedolizumab, and the disease entered latency again.

Discussion CD affects 3 out of 100,000 people, primarily between the second and third decades of life. It is a chronic inflammation that can affect any part of the gastrointestinal tract, with a higher frequency in the ileum, colon, and perianal region. Diagnosis involves clinical, laboratory, radiological, histopathological, and endoscopic data. The anatomopathological analysis may reveal segmental or skip lesions, deep ulcers, stenotic areas, and fistulas. Treatment is based on the disease activity phase, location, medications already used, and adverse effects. In severe cases, both surgical and pharmacological treatments are used, as in the case described, including terminal ileostomy, total proctocolectomy, and vedolizumab. The vedolizumab protocol begins with an intravenous induction phase, followed by intravenous or subcutaneous maintenance. Currently, there is insufficient data to determine if dose escalation benefits patients with a diminished response in subcutaneous maintenance, which is why induction and maintenance are indicated intravenously.

Final Comments CD is a chronic disorder that causes significant morbidity, presenting in a variable manner with periods of activity and remission. Surgical intervention may be a therapeutic option but does not result in a cure. Therefore, longitudinal monitoring of CD patients is essential to adjust treatment as the disease progresses and to improve prognosis.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025