Severe esophageal Crohn's disease: Healing of lesions after 1 week therapy with infliximab

To the Editor: A 38-year-old woman was admitted for axial articular pain associated to a bloody diarrhoea, abdominal pain, weight loss and fever. She also complains of odinophagia, progressive dysphagia, nausea and chest pain; also, she had an history of perianal fistulae. Laboratory findings revealed a moderate anemia (Hb 9.7 g/dl) with an increased ESR and CRP. A colonoscopy with histologic examination indicated a severe Crohn's disease (CD) of the terminal ileum and right colon. A CT scan excluded active fistulae or perianal abscesses while MRI showed the presence of a sacro-ileitis complicating CD. An upper endoscopy revealed deep ulcers, aphthae, and punched-out ulcers at the medium and lower third of the esophagus ( Fig. 1 A). The histology demonstrated a lymphoplasmacytic infiltration of epithelium which extended into the lamina propria destroying the muscular layer; granulomas were not detected. CMV-PCR and immunohistochemical staining for HSV proved to be negative. Finally the diagnosis of non-stricturing/non-penetrating esophageal-ileal-colonic CD was made.