Refractory Very Early-Onset Inflammatory Bowel Disease to Anti-TNF Therapy
DOI:
https://doi.org/10.22516/25007440.1213Keywords:
Inflammatory bowel disease, pediatrics, Crohn’s diseaseAbstract
Background: Very early-onset inflammatory bowel disease (VEO-IBD), defined as symptom onset before the age of 6 years, presents a significant clinical challenge for healthcare teams. This case report aims to share clinical experience in managing a patient with VEO-IBD.
Case Report: We present the case of a 3-year-old boy diagnosed with inflammatory bowel disease (IBD), Crohn’s disease (CD) phenotype, with disease onset at four months of age. A comprehensive evaluation was conducted to rule out differential diagnoses such as food allergies, immunodeficiencies, and intestinal tuberculosis. Given the early onset, a genetic component was suspected, and genetic testing was performed. The patient presented with pancolitis and perianal involvement and was stratified as high-risk according to the ECCO-ESPGHAN guidelines. After therapeutic failure with infliximab and adalimumab, ustekinumab was initiated with successful clinical remission to date. This therapy has proven effective in refractory pediatric CD cases.
Conclusions: To achieve an accurate diagnosis in suspected pediatric IBD, it is essential to follow clinical practice guidelines and apply individualized diagnostic approaches. Although most VEO-IBD cases have multifactorial etiology, genetic factors may play a significant role, particularly in children under 2 years of age. VEO-IBD is often associated with more severe disease in terms of extent and behavior.
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