Infliximab as ultima ratio in a case of refractory non-Crohn’s disease complex fistula system: case report and mini-review of the literature - Report - MDSpire
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Infliximab as ultima ratio in a case of refractory non-Crohn’s disease complex fistula system: case report and mini-review of the literature
Infliximab as a Last Resort for Managing Refractory Non-Crohn’s Disease Fistula
Overview
This case study demonstrates the potential effectiveness of infliximab (IFX) in treating refractory non-Crohn’s disease fistulas. A 76-year-old male patient showed significant clinical improvement and reduced presacral wound cavity size after IFX therapy, suggesting a possible role for IFX in non-CD-related fistulas when other treatments fail.
Background
Infliximab has been a cornerstone in the treatment of perianal fistulizing Crohn’s disease since 1999, yet its application in non-Crohn’s disease fistulas is not well established. The involvement of tumor necrosis factor (TNF) in both Crohn’s and non-Crohn’s fistulas raises questions about the potential for IFX to be effective in non-CD cases. Understanding the therapeutic options for refractory fistulas is crucial, especially when surgical and endoscopic interventions have failed.
Data Highlights
Parameter
Value
Initial presacral wound cavity size (March 2024)
37 mm × 43 mm × 62 mm
Presacral wound cavity size (May 2025)
23 mm × 22 mm × 45 mm
Weight gain after 22 weeks of therapy
6 kg
Key Findings
Infliximab was administered as induction therapy (5 mg/kg every 2 weeks) followed by maintenance therapy (5 mg/kg every 8 weeks).
Significant clinical improvement was reported within 2 weeks of starting IFX therapy.
At 1-year follow-up, the patient had no further hospitalizations due to uncontrolled infection.
The presacral wound cavity size decreased significantly after 1 year of therapy.
The frequency of urinary tract infections did not increase during IFX therapy.
Clinical Implications
This case suggests that infliximab may be a viable treatment option for patients with non-Crohn’s disease fistulas when conventional surgical and endoscopic treatments have failed. Clinicians should consider IFX in refractory cases, particularly in patients with significant TNF involvement.
Conclusion
Infliximab shows promise as a therapeutic option for managing refractory non-Crohn’s disease fistulas, warranting further investigation into its efficacy in this context.
