Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 4048-4062
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.4048
Resolution of Crohn's disease and complex regional pain syndrome following treatment of paratuberculosis
J Todd Kuenstner, William Chamberlin, Saleh A Naser, Michael T Collins, Coad Thomas Dow, John M Aitken, Stuart Weg, Grzegorz Telega, Kuruvilla John, David Haas, Torsten M Eckstein, Maher Kali, Christine Welch, Thomas Petrie
J Todd Kuenstner, Department of Pathology, Charleston Area Medical Center, Charleston, WV 25304, United States
William Chamberlin, Department of Gastroenterology, Mountain View Regional Hospital, Las Cruces, NM 88011, United States
Saleh A Naser, Burnett School of Biomedical Sciences, UCF College of Medicine, Orlando, FL 32816, United States
Michael T Collins, Department of Pathobiological Sciences, the University of Wisconsin School of Veterinary Medicine, Madison, WI 53706, United States
Coad Thomas Dow, 5 Damon Street, Eau Claire, WI 54701, United States
John M Aitken, Otakaro Pathways Ltd., 63 Bibiana Street, Christchurch 8011, New Zealand
Stuart Weg, Patients Medical, Alternative Pain Management, 800 Second Avenue Suite 900, New York City, NY 10017, United States
Grzegorz Telega, Children’s Hospital of Wisconsin, 8915 W. Connell Ave., Milwaukee, WI 53226, United States
Kuruvilla John, Department of Neurosciences, Charleston Area Medical Center, Charleston, WV 25304, United States
David Haas, Department of Chemistry, University of Charleston, Charleston, WV 25304, United States
Torsten M Eckstein, Department of Microbiology, Colorado State University, Immunology and Pathology, CO 80523, United States
Maher Kali, CAMC Clinical Trials Center, 3100 MacCorkle Avenue S.E., Suite 806, Charleston, WV 25304, United States
Christine Welch, CAMC Clinical Trials Center, Charleston, WV 25304, United States
Thomas Petrie, AVIcure Bioscience LLC, Superior Quartz Products, Bethlehem, PA 18020, United States
Author contributions: Kuenstner JT conceived of the combined UVBI and antibiotic treatment protocol and discovered the MAP infections in all of the cases; Chamberlin W and Telega G were the treating physicians for patient 1 and Chamberlin W, Weg S and John K were the treating physicians for patient 2; Naser SA, Collins MT and Aitken JM performed MAP cultures and MAP serologic assays on patients 1 through 5; Eckstein TM performed a serologic assay for leprosy on patient 2 and provided guidance on the presentation of the case reports and interpretation of the MAP literature; Haas D performed extensive analytic spectroscopic tests to confirm the chemical composition of a medication taken by patient 2; Dow CT conceived some of the theoretical basis of the study and contributed some of the references relating to human infection by MAP; Kali M and Welch C performed the statistical analysis which is a key part of the discussion; Petrie T designed and built the UVBI machine which was used to treat patients 1 and 2.
Ethics approval: Because of the devastating nature of the diseases in case 1 and case 2 and the poor record of efficacy, standard therapies were eschewed. Institutional review board approval was not sought since the law allows off label use of FDA approved drugs and also allows the administration of UVBI in New York; IRB approval is generally not required in the care of individual patients.
Informed consent: Informed consent was not sought from each of the patients in this series of case reports since each patient was treated individually and did not enroll in a formal study. Unless an operative procedure or blood transfusion is intended, physicians caring for individual patients who are not part of a formal study, do not routinely seek informed consent from their patients.
Conflict-of-interest: Kuenstner and Petrie are shareowners of AVIcure Bioscience, LLC which has a proprietary interest in the UVBI therapy described above; Naser has a proprietary interest (US Patent 7488580 B1) in a MAP test which has been licensed to Quest Diagnostics Inc. Collins is a co-inventor of a MAP serologic assay (US Patent 8158371 B1) and consultant to IDEXX Laboratories, Inc. and Zoetis Diagnostics.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: J Todd Kuenstner, MD, Department of Pathology, Charleston Area Medical Center, 3200 MacCorkle Ave. SE, Charleston, WV 25304, United States.
Telephone: +1-304-388-4393 Fax: +1-304-388-4352
Received: October 22, 2014
Peer-review started: October 27, 2014
First decision: November 14, 2014
Revised: December 2, 2014
Accepted: January 8, 2015
Article in press: January 8, 2015
Published online: April 7, 2015
Core Tip

Core tip: Five patients with multiple diseases of unknown etiology were found to have evidence of infection by Mycobacterium avium subsp. paratuberculosis (MAP) including positive blood cultures (except in case 4). Two of the cases (case 1 with Crohn’s disease and asthma and case 2 with complex regional pain syndrome, hypothyroidism and Raynaud’s phenomenon) have been treated with a combination of anti-MAP antibiotics and ultraviolet blood irradiation therapy with resolution of the disease symptomatology and inability to culture MAP in post treatment blood samples. These case reports of patients with MAP infections provide supportive evidence of a pathogenic role of MAP in humans.