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.
