Treatment of Crohn's disease in children with adalimumab after being infected with SARS-CoV-2 at Children's Hospital No. 2: A case report

Abstract

Covid-19 disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may lead to a severe inflammatory response or cytokine storm. Immune dysfunction in untreated Crohn’s disease may augment the risk for a severe inflammatory response to Covid-19. It is estimated that about 2% of severe children need to be hospitalised and the mortality rate is about 0.08%. Crohn’s disease most commonly occurs in the small intestine and the colon. It can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus.  Crohn’s patients on immunosuppressive medical therapy may encounter an increased SARS-CoV-2 infection risk. By contrast, immunosuppressive therapy may also have a potential benefit on clinical outcomes in Covid-19, since it may suppress not only mucosal inflammation but also the severe acute respiratory syndrome SARS-CoV-2-driven systemic inflammatory immune response. Adalimumab therapy can effectively treat both pediatric Crohn’s disease and multisystem inflammatory syndrome in children temporally associated with coronavirus disease 2019 infection. However, the management and follow-up plan still needs more consensus because it almost depends on steroids, adalimumab, and other drugs. Covid-19 in patients with Crohn's disease has not been well documented in the literature. Therefore, in this study, the authors reported a case of a pediatric Crohn's disease successfully treated with adalimumab after infected coronavirus 2 at Children's Hospital No. 2 from September 7, 2021 to November 4, 2021.