New onset of grave’s disease during anti-tnfα treatment in a case of fistulizing crohn’s disease

IBD P-254 New onset of grave’s disease during anti-tnfα treatment in a case of fistulizing crohn’s disease Presenting Author: NAWAF ZAKARY Additional Authors: ALGUILI ELSHEIKH, NOOF HAMID, OMAR ABDULAAL, MOHAMMED ALGHAMDI, WALID FARAH Corresponding Author: NAWAF ZAKARY Affiliations: King Fahad Military Medical Complex, King Fahad Military Medical Complex, King Fahad Military Medical Complex, King Fahad Military Medical Complex, King Fahad Military Medical Complex Objective: The association between inflammatory bowel disease in form of ulcerative colitis and autoimmune thyroid disease has been well documented. However, the association between crohn’s disease and autoimmune thyroid disease is not well established and there have only been a few reported cases in the literature. Case presentation We present here a rare case of a 35-year-old Saudi female with simultaneous onset of Graves’ disease and fistulizing Crohn’s disease. Crohn’s disease was complicated with intra-abdominal fistulas. Despite intense medical treatment with regular Azathioprine, total parenteral nutrition, antibiotics, and corticosteroids the clinical course of the disease was suboptimal. Finally, the patient underwent laparotomy and right hemi-colectomy with ileo-transverse anastomosis, simultaneous drainage of the abdominal abscess and closure of the opening. Although the surgical approach cured the perforating complications of the disease (fistulas and abscess), the luminal disease in the colon remnant was still active. The subsequent successful treatment with infliximab, azathioprine and mesalazine resulted in the induction and maintenance of the disease remission. Later on, patient develop full blown picture of Graves’ disease after she started infliximab which was stopped later and the patient improved on antithyroid medication. Conclusion: We are not sure whether the association between Crohn’s disease and Gravés disease is infliximab dependent or independent and it needs more case studies and research. KeyWord(s): 1. Gravés disease; 2. Crohn’s disease; 3. ulcerative colitis; 4. infliximab; 5. azathioprine Poster 136 Journal of Gastroenterology and Hepatology 2014; 29 (Suppl. 3): 51–313 © 2014