A case of fistulizing Crohn's disease and erythema nodosum managed with adalimumab

Background A 20-year-old female presented to her gastroenterologist with fevers and right-labial pain and swelling. Painful erythematous nodules developed in her pretibial region soon after admission to a medical ward. She had a 10-year history of Crohn's colitis, perirectal abscesses and fistulizing disease, and had undergone a diverting ileostomy 16 months earlier; however, she was not on any medication for her Crohn's disease owing to her history of drug intolerance and side effects. Investigations Physical examination, laboratory investigations, examination under anesthesia, proctoscopy, MRI, and skin biopsy. Diagnosis Active Crohn's disease with perianal fistula and sigmoid colitis, and erythema nodosum. Management Subcutaneous injections of adalimumab: an initial 160 mg dose, followed by 80 mg in week 2 and then 40 mg every other week. Antibiotics were also prescribed.