Crohn’s Disease, Pregnancy and Psychiatric Disturbances – a Case Report

Abstract: Crohn’s disease (CD) is a disorder characterized by transmural inflammation of the gastrointestinal tract. The peak onset of CD coexists with the reproductive period, but it doesn’t seem to affect fertility. A course of pregnancy and mode of delivery comprise challenging clinical problem. An 18-year-old woman was diagnosed with CD involving terminal ileum and the left side of the colon. Due to intolerance of thiopurines and non-acceptance of methotrexate, maintenance therapy consisted only of mesalamine and budesonide. Ten years later presence of a fistula penetrating from sigmoid part of colon towards the left fallopian tube brought about a hemicolectomy with colostomy creation. As a next step infliximab was started, but it led to a severe exacerbation of psoriasis. Treatment with adalimumab was not effective. High doses of glucocorticoids resulted in an improvement but also in psychiatric complications. At the age of 30 the woman became pregnant. The pregnancy was uneventful from the gastrological point of view, but in 25/52 the woman experienced an acute psychotic disorder. In 40/52 she delivered vaginally a healthy child. After the delivery a disease flare appeared. The patient accepted methotrexate and achieved a temporary remission. The next flare presented with new fistulae. The patient was once again referred to a surgery. The course of CD may be extremely difficult to control. Standard treatment might lead to severe side effects. In majority of CD patients, the course of pregnancy is uneventful, but the post-delivery time is usually connected with a disease flare.

Gabriela Mielecka, Anna Niziol, Agnieszka Piatek-Guziewicz

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