Ustekinumab en paciente con enfermedad de Crohn y psoriasis inducida por anti-TNF-¦Á / Ustekinumab in a patient with Crohn's disease and anti-TNF-¦Á-induced psoriasis

El tratamiento con farmacos antifactor de necrosis tumoral alfa (TNF-¦Á) en la enfermedad de Crohn es relativamente seguro aunque se han comunicado diferentes efectos secundarios cutaneos como la aparicion o exacerbacion de una psoriasis secundaria al tratamiento con anti-TNF-¦Á que, en ocasiones, puede llevar a la suspension del tratamiento. Por ello, son necesarias nuevas alternativas terapeuticas con nuevos mecanismos de accion. Se ha publicado que ustekinumab, un anticuerpo monoclonal que se une a la subunidad p40 de la interleucina 12/23, podrea inducir repuesta en pacientes con enfermedad de Crohn y ademas ha demostrado su eficacia en pacientes con psoriasis. Presentamos un caso de una paciente con enfermedad de Crohn que desarrollo psoriasis tras el tratamiento con 2 farmacos anti-TNF-¦Á (infliximab y adalimumab) que fue posteriormente tratada con ustekinumab con resolucion de las lesiones de la psoriasis y mantuvo la remision de la enfermedad de Crohn (AU)

Treatment with anti-tumor necrosis factor (TNF)-¦Á for Crohn's disease is relatively safe, although various cutaneous adverse effects have been reported such as the development or exacerbation of anti-TNF- ¦Á-induced psoriasis, which can sometimes lead to treatment withdrawal. Therefore, new alternative treatments with new mechanisms of action are required. Ustekinumab, a monoclonal antibody against the p40 subunit of interleukin 12/23, could induce response in patients with Crohn's disease and has demonstrated efficacy in patients with psoriasis. We present the case of a woman with Crohn's disease who developed psoriasis after treatment with two anti-TNF- ¦Á drugs (infliximab and adalimumab). The patient was subsequently treated with ustekinumab with resolution or psoriasis lesions and maintenance of remission of Crohn's disease (AU)

[Ustekinumab in a patient with Crohn's disease and anti-TNF-α-induced psoriasis]. / Ustekinumab en paciente con enfermedad de Crohn y psoriasis inducida por anti-TNF-α

Treatment with anti-tumor necrosis factor (TNF)-α for Crohn's disease is relatively safe, although various cutaneous adverse effects have been reported such as the development or exacerbation of anti-TNF- α-induced psoriasis, which can sometimes lead to treatment withdrawal. Therefore, new alternative treatments with new mechanisms of action are required. Ustekinumab, a monoclonal antibody against the p40 subunit of interleukin 12/23, could induce response in patients with Crohn's disease and has demonstrated efficacy in patients with psoriasis. We present the case of a woman with Crohn's disease who developed psoriasis after treatment with two anti-TNF- α drugs (infliximab and adalimumab). The patient was subsequently treated with ustekinumab with resolution or psoriasis lesions and maintenance of remission of Crohn's disease.

[Esophageal stenosis in eosinophilic esophagitis]. / Estenosis esofágica en una esofagitis eosinofílica.

Eosinophilic esophagitis is a rare, recently discovered disease, characterized by esophageal symptoms, such as dysphagia and food impaction, associated with dense eosinophilia on endoscopic biopsy of the esophagus. Other entities such as gastroesophageal reflux disease are absent and there is a lack of response to proton pump inhibitor therapy. This disease mainly affects the pediatric population but is becoming more prevalent in adults. There are several theories on the etiopathogenesis of this entity, which may involve allergies and atopy. In advanced disease, complications such as esophageal stenosis can appear. Treatment is based on dietary elimination, corticosteroids and endoscopic dilatation. We report a case of eosinophilic esophagitis with esophageal stenosis.

Estenosis esofágica en una esofagitis eosinofílica / Esophageal stenosis in eosinophilic esophagitis

La esofagitis eosinofílica es una enfermedad rara, descubiertarecientemente, que se caracteriza por síntomas esofágicos,como disfagia e impactación de alimentos. Se asocia con unadensa eosinofilia en la biopsia endoscópica del esófago, perono con otras afecciones, como la enfermedad por reflujo gastroesofágico.No responde al tratamiento con inhibidores dela bomba de protones. Es una enfermedad fundamentalmentepediátrica, pero su prevalencia en adultos está aumentando.Hay varias teorías sobre su etiopatogenia que larelacionan con las alergias y la atopia. En su curso evolucionadopueden aparecer complicaciones, como estenosis esofágicas.El tratamiento se basa en dietas de exclusión, corticoidesy dilataciones endoscópicas. Se presenta un caso clínicode esofagitis eosinofílica con estenosis esofágica

Eosinophilic esophagitis is a rare, recently discovered disease,characterized by esophageal symptoms, such as dysphagiaand food impaction, associated with dense eosinophiliaon endoscopic biopsy of the esophagus. Other entities suchas gastroesophageal reflux disease are absent and there is alack of response to proton pump inhibitor therapy. This diseasemainly affects the pediatric population but is becomingmore prevalent in adults. There are several theories onthe etiopathogenesis of this entity, which may involve allergiesand atopy. In advanced disease, complications such asesophageal stenosis can appear. Treatment is based on dietaryelimination, corticosteroids and endoscopic dilatation.We report a case of eosinophilic esophagitis with esophageal stenosis