I.
Shafran, C. Piromalli, S. Naser
In this case report, a Crohn's patient
was found to be PCR positive for Mycobacterium
avium subspecies paratuberculosis
(M para) with a positive serologic
response to p35 and p36 antigens (recombinant clones expressing a 35K and 36K
protein from M para genomic library),
and has demonstrated significant healing (>80%) of an ulcer seen in the ileum
at endoscopy. This healing was observed after the patient underwent a
combination of rifabutin and macrolide therapy. This 65-y/o male had Crohn's
disease (CD), diagnosed at age 30, that was confined to his colon and treated
with corticosteroids for 17 yrs. A proctocolectomy and Brookes ileostomy were
done in 1980. He remained symptom free and off all medications until April, 1998
when he developed colicky abdominal pain and weight loss. He was endoscoped
through his stoma and found to have a 4.0 cm. aphthous ulcer.
The remaining ileum was unremarkable to a depth of 120 cm. Histology showed
typical features of CD. The patient
consented to treatment with macrolide antibiotics 250 mg. twice a day and
rifabutin 150 mg. daily. He became asymptomatic in 2 weeks and a follow-up
endoscopy was done after completing 1 month of treatment.
The 4 cm. ulcer, noted 1 month before, had decreased to 1 cm. with excellent
re-epithelialization from the edge of the ulcer inward. The remaining ileum to
120 cm. was normal. The patient has remained symptom free and continues
antibiotics. In conclusion, this is the first known case of CD treated with this
combination of antibiotics with documented clinical and endoscopic healing. The
endoscopic observations reported further substantiate the possible role of M
para in the etiology of CD and the possible use of antibiotic treatment for
CD. Currently, 14 CD patients are undergoing similar treatment to
further validate the role of M para in
CD and the efficacy of antibiotic treatment.
All content copyright ©1999 Dr. Ira Shafran, M.D.