Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://gr.elmerpub.com

Case Report

Volume 17, Number 5-6, December 2024, pages 217-223

Treatment of Crohn’s Disease With Infliximab and Subsequent Development of Takayasu’s Arteritis

Figure 1. Colonoscopy revealed ulcer scars throughout the large intestine, but the mucosa appeared to be in remission.

Figure 2. Computed tomography revealed wall thickening of the thoracoabdominal aorta and bilateral renal arteries (arrow in the left image) as well as focal stenosis (arrow in the right image) at the origin of the right renal artery.

Figure 3. Positron emission tomography-computed tomography revealed abnormal accumulation around the celiac artery and para-aortic lymph nodes.

**Table 1.** Laboratory Findings on Admission
ANA: anti-nuclear antibodies; APTT: activated partial thromboplastin time; MPO-ANCA: myeloperoxidase anti-neutrophil cytoplasmic antibodies; PR3-ANCA: proteinase 3 ANCA; PT-INR: prothrombin time-international normalized ratio; sIL-2R: soluble interleukin-2 receptor.
White blood cells	14,200/µL
Red blood cells	458 × 10⁴/µL
Hemoglobin	13.3 g/dL
Hematocrit	38%
Mean corpuscular volume	83 fL
Reticulocytes	0.9%
Platelets	57.5 × 10⁴/µL
PT-INR	1.36
APTT/con	55.6/33.6 s
Aspartate aminotransferase	45 U/L
Alanine aminotransferase	30 U/L
Lactate dehydrogenase	216 U/L
Alkaline phosphatase	53 U/L
Total protein	8.4 g/dL
Albumin	3 g/dL
Blood urea nitrogen	11 mg/dL
Creatinine	0.91 mg/dL
Uric acid	3.3 mg/dL)
Sodium	132 mEq/L
Potassium	3.8 mEq/L
Chloride	90 mEq/L
Creatinine kinase	47 U/L
Total bilirubin	0.47 mg/dL
Iron	25 µg/dL
Total iron-binding capacity	158 µg/dL
Unsaturated iron-binding capacity	133 µg/dL
Ferritin	584 ng/dL
C-reactive protein	17.2 mg/dL
ANA	< 1:20
PR3-ANCA	2.4 U/mL
MPO-ANCA	< 1.0 U/mL
Carcinoembryonic antigen	3.6 ng/mL
Carbohydrate antigen 19-9	12 U/mL
sIL-2R	1,390 U/mL

Table 1. Laboratory Findings on Admission

ANA: anti-nuclear antibodies; APTT: activated partial thromboplastin time; MPO-ANCA: myeloperoxidase anti-neutrophil cytoplasmic antibodies; PR3-ANCA: proteinase 3 ANCA; PT-INR: prothrombin time-international normalized ratio; sIL-2R: soluble interleukin-2 receptor.

White blood cells

14,200/µL

Red blood cells

458 × 10⁴/µL

Hemoglobin

13.3 g/dL

Hematocrit

38%

Mean corpuscular volume

83 fL

Reticulocytes

0.9%

Platelets

57.5 × 10⁴/µL

PT-INR

1.36

APTT/con

55.6/33.6 s

Aspartate aminotransferase

45 U/L

Alanine aminotransferase

30 U/L

Lactate dehydrogenase

216 U/L

Alkaline phosphatase

53 U/L

Total protein

8.4 g/dL

Albumin

3 g/dL

Blood urea nitrogen

11 mg/dL

Creatinine

0.91 mg/dL

Uric acid

3.3 mg/dL)

Sodium

132 mEq/L

Potassium

3.8 mEq/L

Chloride

90 mEq/L

Creatinine kinase

47 U/L

Total bilirubin

0.47 mg/dL

Iron

25 µg/dL

Total iron-binding capacity

158 µg/dL

Unsaturated iron-binding capacity

133 µg/dL

Ferritin

584 ng/dL

C-reactive protein

17.2 mg/dL

ANA

< 1:20

PR3-ANCA

2.4 U/mL

MPO-ANCA

< 1.0 U/mL

Carcinoembryonic antigen

3.6 ng/mL

Carbohydrate antigen 19-9

12 U/mL

sIL-2R

1,390 U/mL

**Table 2.** Review of the Literature on Takayasu’s Arteritis With Anti-Tumor Necrosis Factor-α Agents Associated With Crohn’s Disease
References	Age	Sex	Diagnostic order	Type of CD	Anti-TNF-α agent	Clinical presentation	Steroid for TA	Tests to diagnose TA
F: female; M: male; ADA: adalimumab; CD: Crohn’s disease; CT: computed tomography; CTA: computed tomography angiography; IFX: infliximab; MRI: magnetic resonance imaging; ND: not determined; NMR: nuclear magnetic resonance; PET: positron emission tomography; TA: Takayasu’s arteritis; TNF: tumor necrosis factor; US: ultrasonography.
Domenech et al, 2005 [5]	27	F	CD → TA	Ileocolonic	IFX	Fever, epigastric pain, vomiting	1 mg/kg/day	CT, angio-NMR
Kellermayer et al, 2008 [6]	17	F	CD → TA	Colonic	IFX	Nausea, emesis	None	Contrast-enhanced CT, MRI
El-Matary et al, 2009 [7]	15	F	CD → TA	Ileocolonic	IFX	Fever, headache, vomiting, abdominal pain	Done	CT, MRI angiogram
Katoh et al, 2010 [8]	20	F	CD → TA	Ileocolonic	IFX	Anterior neck pain	40 mg/day	Contrast-enhanced CT, US
Okada et al, 2010 [9]	30	M	CD → TA	Ileocolonic	IFX	Neck pain	60 mg/day	Contrast-enhanced CT, MRI, CTA, PET
Osman et al, 2011 [10]	17	F	CD → TA	ND	IFX	ND	20 mg/day	Contrast-enhanced CT
Kiyohara et al, 2015 [11]	23	F	CD → TA	Ileocolonic	ADA	Fever, abdominal pain	40 mg/day	Contrast-enhanced CT
Sy et al, 2016 [12]	13	M	CD → TA	ND	IFX	ND	Done	ND
	15	F	CD → TA	ND	IFX	ND	None	ND
	8	F	CD → TA	ND	IFX	ND	Done	ND
	9	F	CD → TA	ND	IFX	ND	Done	ND
Miyakawa et al, 2016 [13]	19	M	CD → TA	Ileocolonic	IFX	Fever	40 mg/day	Contrast-enhanced CT, CTA
Takeuchi et al, 2020 [14]	10	M	CD → TA	Ileocolonic	IFX, ADA	Neck pain	30 mg /day	Contrast-enhanced CT
Kollen et al, 2020 [15]	6	M	CD → TA	Ileocolonic	IFX	Back and chest pain, fever	Done	CT, MRI, PET
Kishimoto et al, 2021 [16]	14	M	CD → TA	Ileocolonic	IFX	Fever, pain in right arm	15 mg/day	Contrast-enhanced CT, PET
Fotis et al, 2022 [17]	15	F	CD → TA	Ileocolonic	IFX	Fever	40 mg /day	CT, MRI angiogram, PET
Ariga et al, 2024 [18]	23	F	CD → TA	Colonic	IFX	Abdominal pain	Done	CT, PET
Present patient	23	M	CD → TA	Colonic	IFX	Fever, headache	50 mg/day	Contrast enhanced CT, CTA, PET

Table 2. Review of the Literature on Takayasu’s Arteritis With Anti-Tumor Necrosis Factor-α Agents Associated With Crohn’s Disease

References

Age

Sex

Diagnostic order

Type of CD

Anti-TNF-α agent

Clinical presentation

Steroid for TA

Tests to diagnose TA

F: female; M: male; ADA: adalimumab; CD: Crohn’s disease; CT: computed tomography; CTA: computed tomography angiography; IFX: infliximab; MRI: magnetic resonance imaging; ND: not determined; NMR: nuclear magnetic resonance; PET: positron emission tomography; TA: Takayasu’s arteritis; TNF: tumor necrosis factor; US: ultrasonography.

Domenech et al, 2005 [5]

CD → TA

Ileocolonic

IFX

Fever, epigastric pain, vomiting

1 mg/kg/day

CT, angio-NMR

Kellermayer et al, 2008 [6]

CD → TA

Colonic

IFX

Nausea, emesis

None

Contrast-enhanced CT, MRI

El-Matary et al, 2009 [7]

CD → TA

Ileocolonic

IFX

Fever, headache, vomiting, abdominal pain

Done

CT, MRI angiogram

Katoh et al, 2010 [8]

CD → TA

Ileocolonic

IFX

Anterior neck pain

40 mg/day

Contrast-enhanced CT, US

Okada et al, 2010 [9]

CD → TA

Ileocolonic

IFX

Neck pain

60 mg/day

Contrast-enhanced CT, MRI, CTA, PET

Osman et al, 2011 [10]

CD → TA

IFX

20 mg/day

Contrast-enhanced CT

Kiyohara et al, 2015 [11]

CD → TA

Ileocolonic

ADA

Fever, abdominal pain

40 mg/day

Contrast-enhanced CT

Sy et al, 2016 [12]

CD → TA

IFX

Done

CD → TA

IFX

None

CD → TA

IFX

Done

CD → TA

IFX

Done

Miyakawa et al, 2016 [13]

CD → TA

Ileocolonic

IFX

Fever

40 mg/day

Contrast-enhanced CT, CTA

Takeuchi et al, 2020 [14]

CD → TA

Ileocolonic

IFX, ADA

Neck pain

30 mg /day

Contrast-enhanced CT

Kollen et al, 2020 [15]

CD → TA

Ileocolonic

IFX

Back and chest pain, fever

Done

CT, MRI, PET

Kishimoto et al, 2021 [16]

CD → TA

Ileocolonic

IFX

Fever, pain in right arm

15 mg/day

Contrast-enhanced CT, PET

Fotis et al, 2022 [17]

CD → TA

Ileocolonic

IFX

Fever

40 mg /day

CT, MRI angiogram, PET

Ariga et al, 2024 [18]

CD → TA

Colonic

IFX

Abdominal pain

Done

CT, PET

Present patient

CD → TA

Colonic

IFX

Fever, headache

50 mg/day

Contrast enhanced CT, CTA, PET