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[The prolonged administration of intravenous immunoglobulins as a treatment for refractory fistulous
Gonzalez-Lara V, Carneros JA, Nunez-Martinez O, Rodriguez C, Escudero M, Alvarez R.
Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Maranon, Madrid.
Fistulating Crohn's disease is present in 17-35% of non-surgically treated patients and in up to 45% of
surgically treated ones. Among the several therapeutic alternatives for this disease is intravenous
immunoglobulin administration. We present a 28-year-old woman with refractory fistulating
Crohn's disease who improved after prolonged immunoglobulin administration (32 months).
Review of Reported Cases
PMID: 10726377 [PubMed - indexed for MEDLINE]
Scand J Gastroenterol. 1998 Oct;33(10):1113-7.
A case of Crohn's disease with increased CD8 T-cell activation and remission during therapy with intravenous immunoglobulins.
Korber J, Kottgen E, Renz H.
Medical Clinic and Policlinic, and Institute of Laboratory Medicine and Pathobiochemistry, Charite Campus Virchow-Klinikum, Humboldt University of Berlin, Germany.
BACKGROUND: Crohn's disease (CD) represents a chronic inflammatory bowel disease with abnormal
CD8 T-cell function in a subgroup of patients. METHODS: A 55-year-old woman presented with CD on the
basis of clinical, endoscopic, radiologic, histologic, and sonographic examination. Since the disease
could not be controlled with conventional anti-inflammatory therapy, a detailed analysis of cellular
and humoral immune functions was performed and showed a dysbalanced T-cell activation pattern with
an inverse CD4/CD8 ratio due to an increased number of CD8 T cells. Additionally, high IgM
and low IgG2 antibody levels were detected. Treatment with intravenous immunoglobulin (IVIG)
was started as immunomodulatory therapy. During this therapy the condition improved markedly.
CD8 T-cell levels returned to normal, and IgM decreased as well. CONCLUSION: This case shows
that selected cases of CD may be associated with abnormal functions and that such patients may
benefit from IVIG treatment.
PMID: 9829369 [PubMed - indexed for MEDLINE]
Am J Gastroenterol. 1992 Jan;87(1):91-100.
Intravenous immunoglobulin therapy for active, extensive, and medically refractory idiopathic ulcerative or Crohn's colitis.
Levine DS, Fischer SH, Christie DL, Haggitt RC, Ochs HD.
Department of Medicine, University of Washington Medical Center, Seattle.
To determine whether intravenous immunoglobulin produces demonstrable clinical improvement i
n patients with refractory idiopathic inflammatory bowel disease, a pilot, open-label, nonrandomized
, safety and therapeutic efficacy study was carried out at a tertiary care referral medical center.
Twelve consecutive patients with refractory idiopathic colitis (nine ulcerative colitis, three Crohn's colitis)
who were reluctant to receive immunosuppressive therapy or have surgical intervention were
referred by physicians not participating as investigators in this study. Eleven patients were symptomatic
for at least 6 months, with endoscopically moderate or severe mucosal inflammation despite
medical therapy, including systemic corticosteroids in all cases, and one patient was
dependent on oral prednisone to remain in clinical remission. Ten patients had extensive colitis,
six of whom had pancolitis and four of whom had colitis extending to the hepatic flexure or transverse
colon. Nine patients required hospitalization for treatment of colitis. Intravenous immunoglobulin was
administered in one or two induction phases (2 g/kg over 2 or 5 days), followed by a maintenance phase
(200-500 mg/kg every 2 wk for 12 or 24 wk). Tapering of systemic corticosteroid therapy was attempted,
whereas other medications for idiopathic colitis were continued. Treatment response was assessed
clinically and by colonoscopy with multiple biopsies whenever possible. Immunoglobulin therapy was
well-tolerated and did not produce any biochemical abnormalities. In six patients who completed
the treatment protocol, mean reductions +/- SE were achieved in subjective symptoms as quantified by
a colitis activity score, 13.3 +/- 1.2 to 4.7 +/- 0.9 (p less than 0.001), and daily mg dose of prednisone,
41.7 +/- 8.0 to 1.9 +/- 1.2 (p less than 0.001). For all 12 patients, statistically significant reductions were
achieved in the colitis activity score and daily prednisone dose. Of five patients who completed the
treatment protocol and improved clinically, four underwent post-treatment colonoscopic and biopsy
evaluations and had unequivocal reductions in the intensity of colonic mucosal inflammation. Three
patients who had objective improvement with intravenous immunoglobulin experienced relapses of
colitis after discontinuation of this therapy. Six patients did not complete the treatment protocol,
two of whom required surgical intervention and four of whom withdrew to undergo colectomy electively.
Intravenous immunoglobulin may be beneficial in subsets of patients with idiopathic colitis. The results
of our pilot study justify the undertaking of a prospective, randomized controlled trial to determine the
efficacy of intravenous immunoglobulin in carefully defined subsets of patients with idiopathic inflammatory bowel disease.
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