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BMJ Case Rep. 2010; 2010: bcr04.2009.1739.
Published online 2010 January 13. doi:  10.1136/bcr.04.2009.1739
PMCID: PMC3027916
Novel treatment (new drug/intervention; established drug/procedure in new situation)

Anti-TNFα antibody infliximab treatment for an infant with fistulising Crohn’s disease


A female infant presented at the age of 4 weeks with dyschezia and bloody streaking of stools which did not improve on elemental formula for proposed cow’s milk protein allergy. At 6 months of age perianal ulceration appeared which evolved into multiple fistulas opening into the perineum. A diagnosis of infantile Crohn’s disease was made after colonoscopy and histopathology examination and exclusion of other conditions. An 8 week trial of total parenteral nutrition, in addition to corticosteroids, salazopyrine, metronidazole, and azathioprine failed to arrest deterioration of the perianal fistulas. Treatment with the anti-TNFα antibody infliximab was started at 5 mg/kg/dose at 9 months of age. She was given three doses at 0, 2, and 6 weeks, respectively. This resulted in significant healing of her fistulas and cessation of fistula output. This improvement was sustained at the time of last follow-up 10 months after treatment.

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