Oral manifestations of Crohn disease managed with ustekinumab: A case report.

Abstract

Background: The authors reviewed a case involving the orofacial manifestations of Crohn disease (CD) in an adolescent whose treatment was ultimately managed with a newer class of biologic drug agent, ustekinumab (Stelara, Janssen Biotech). CD is a chronic inflammatory condition affecting the gastrointestinal tract that often causes extraintestinal complications. The underlying etiology of CD involves genetic, environmental, and local factors. Orofacial manifestations of CD include gingivitis, mucosal tags, aphthous ulcerations, labial swellings, cobblestoning, and linear ulcers of the oral vestibules.

Case description: A previously healthy 12-year-old boy presented with painful, constant, diffuse oral ulcerations. His diagnostic and laboratory testing supported a diagnosis of CD. The patient was then treated with budesonide (Entocort, Perrigo Company), prednisone (Deltasone, Pfizer Inc), and infliximab infusions (Remicade, Janssen Biotech). Later, he had high levels of anti-infliximab antibodies and inadequate control of his orofacial lesions. He then began taking a different class of biologic medication, ustekinumab. After initiation of ustekinumab, both his oral and intestinal manifestations markedly improved.

Practical implications: Collaboration between the treating dentist and treating gastroenterologist is recommended for management of the orofacial manifestations of CD. This may lead to an improvement in the patient's prognosis and quality of life. Ustekinumab is an anti-p40 antibody that inhibits interleukins 12 and 23. It is a newer biologic medication, and its use has been increasing in the pediatric population with CD. Its use is typical after failure of an antitumor necrosis factor drug, like infliximab.