Case Report
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World J Gastroenterol. Dec 7, 2011; 17(45): 5028-5031
Published online Dec 7, 2011. doi: 10.3748/wjg.v17.i45.5028
Thalidomide induces mucosal healing in Crohn's disease: Case report
Márcio Rios Leite, Sandra Sousa Santos, André Castro Lyra, Jaciane Mota, Genoile Oliveira Santana
Márcio Rios Leite, André Castro Lyra, Genoile Oliveira Santana, Department of Gastroenterology, Prof. Edgard Santos University Hospital, Federal University of Bahia, Salvador, Bahia 40110-060, Brazil
Sandra Sousa Santos, Jaciane Mota, Department of Gastrohepatology, São Rafael Hospital, Monte Tabor Foundation, São Marcos Avenue, 2152, Salvador, Bahia 41256-900, Brazil
Author contributions: Rios Leite M and Santana GO contributed equally to this work; Sousa Santos S and Mota J reviewed the chart and designed the figures; Rios Leite M wrote the paper; Lyra AC and Santana GO reviewed the paper.
Correspondence to: Márcio Rios Leite, MD, Department of Gastroenterology, Prof. Edgard Santos University Hospital, Federal University of Bahia, Augusto Viana Street, Salvador, Bahia 40110-060, Brazil.
Telephone: +55-71-82023372 Fax: +55-71-32357048
Received: January 22, 2011
Revised: May 2, 2011
Accepted: May 9, 2011
Published online: December 7, 2011

Crohn’s disease is a chronic inflammatory disorder of the gastrointestinal tract that is defined by relapsing and remitting episodes. Tumor necrosis factor alpha (TNF-α) appears to play a central role in the pathophysiology of the disease. Standard therapies for inflammatory bowel disease fail to induce remission in about 30% of patients. Biological therapies have been associated with an increased incidence of infections, especially infection by Mycobacterium tuberculosis (Mtb). Thalidomide is an oral immunomodulatory agent with anti-TNF-α properties. Recent studies have suggested that thalidomide is effective in refractory luminal and fistulizing Crohn’s disease. Thalidomide costimulates T lymphocytes, with greater effect on CD8+ than on CD4+ T cells, which contributes to the protective immune response to Mtb infection. We present a case of Crohn’s disease with gastric, ileal, colon and rectum involvement as well as steroid dependency, which progressed with loss of response to infliximab after three years of therapy. The thorax computed tomography scan demonstrated a pulmonary nodule suspected to be Mtb infection. The patient was started on thalidomide therapy and exhibited an excellent response.

Keywords: Anti-tumor necrosis factor alpha, Crohn’s disease, Mucosal healing, Mycobacterium tuberculosis, Thalidomide