Treatment of Fistulas with Granulocyte Colony-Stimulating Factor in a Patient with Crohn's Disease

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Abstract
An adolescent boy with Crohn's disease and enterocutaneous fistulas had a response to treatment with granulocyte colony-stimulating factor (filgrastim) after all standard treatments had failed. The patient presented at the age of eight years with swollen lips. Biopsies of the tongue and oral mucosa showed a chronic inflammatory-cell infiltrate and noncaseating granulomas — findings consistent with the presence of Crohn's disease. At the age of 14 years, rectal inflammation and a perianal fistula developed. The boy had a response to treatment with prednisolone and metronidazole, but the perianal pain recurred when the prednisolone was discontinued. He was then treated with mercaptopurine, metronidazole, and prednisolone, which resulted in a decrease in pain but no healing of the fistula. After discontinuation of the prednisolone, a large abscess developed on the buttock; it was treated with antibiotics. The perianal fistula enlarged, and the boy became unable to walk. The dose of mercaptopurine was increased, and metronidazole was continued, without improvement. A diverting colostomy was performed, and a distal colocutaneous mucus fistula was created. There was no improvement, and a fistula between the abdominal wall and the sigmoid colon developed.