METHODS: A young female with severe Crohn\'s disease, treated with the TNF-alpha inhibitor infliximab, developed friable pseudomembranous oral ulcerations. Histopathological and immunofluorescence analyses confirmed these as PV. The treatment included clobetasol propionate and low-level photobiomodulation, which resulted in partial improvement. The patient later experienced severe intestinal bleeding, requiring intravenous hydrocortisone therapy, which improved both her systemic condition and oral lesions. Weeks later, new ulcerations caused by herpes virus and candidiasis were identified, leading to treatment with oral acyclovir, a 21-day regimen of oral nystatin rinse, and photodynamic therapy, ultimately healing the oral infections. To manage her condition, the gastroenterologists included methotrexate (25 mg) in her regimen to reduce the immunogenicity of infliximab and minimize corticosteroid use, as the patient was in remission for Crohn\'s disease, and the oral PV lesions were under control.
CONCLUSIONS: Young patients with Crohn\'s disease should be referred to an oral medicine specialist for comorbidity investigation, as oral PV and opportunistic infections can arise during immunosuppressive therapy. The use of TNF-alpha inhibitors in patients treated for inflammatory bowel disease, such as Crohn\'s, should be carefully evaluated for potential side effects, including oral PV.
方法:一名患有严重克罗恩病的年轻女性,用TNF-α抑制剂英夫利昔单抗治疗,出现脆性假膜性口腔溃疡。组织病理学和免疫荧光分析证实这些为PV。治疗包括丙酸氯倍他索和低水平光生物调节,这导致了部分改进。患者后来出现严重的肠出血,需要静脉注射氢化可的松治疗,改善了她的全身状况和口腔病变。几周后,发现了由疱疹病毒和念珠菌病引起的新的溃疡,导致口服阿昔洛韦治疗,21天的口服制霉菌素冲洗方案,光动力疗法,最终治愈口腔感染。为了控制她的病情,胃肠病学家在她的治疗方案中包括甲氨蝶呤(25毫克),以降低英夫利昔单抗的免疫原性并尽量减少皮质类固醇的使用,因为病人正在缓解克罗恩病,口腔PV病变得到控制。
结论:患有克罗恩病的年轻患者应转诊至口腔医学专家进行合并症调查,因为免疫抑制治疗期间可能出现口腔PV和机会性感染。在治疗炎症性肠病的患者中使用TNF-α抑制剂,比如克罗恩,应该仔细评估潜在的副作用,包括口服PV。