CASE REPORT
Ahead of print publication

Behçet's disease-induced massive small intestinal bleeding successfully treated with adalimumab

Correspondence Address:
JW Chou,
Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung
Taiwan

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpgm.jpgm_931_22

PMID: 37357487

We herein report a case of Behçet's disease in a 27-year-old female who suffered from generalized skin rashes for one week. After hospitalization, massive bloody stools accompanying hypovolemic shock occurred. Emergency abdominal computed tomography-angiography failed to detect the bleeding source. Esophagogastroduodenoscopy also demonstrated no definite bleeding points. Ileocolonoscopy showed multiple large and deep ulcers with some blood coating and mild oozing in the terminal ileum. We initially performed epinephrine injection and hemoclips for her intestinal bleeding. However, massive bloody stools still continued. Thus, we prescribed a loading dose of 160 mg adalimumab followed by weekly 80 mg adalimumab subcutaneous injections to the patient. Following this treatment, her gastrointestinal bleeding gradually subsided and completely stopped within a few days. After three-week therapy with adalimumab, capsule endoscopy showed several healing ulcers without bleeding in the distal to the terminal ileum. She continues to be treated with adalimumab, azathioprine, and mesalazine without recurrent bleeding.

Keywords: Adalimumab, Behcet's disease, capsule endoscopy, small intestinal bleeding