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Anti-TNF-α therapy for orofacial granulomatosis: proceed with caution
  1. D R Gaya,
  2. S Aitken,
  3. J Fennell,
  4. J Satsangi,
  5. A G Shand
  1. Gastrointestinal Unit, Molecular Medicine Centre, University of Edinburgh, Western General Hospital, Edinburgh, UK
  1. Correspondence to:
    Dr D R Gaya
    Gastrointestinal Unit, Molecular Medicine Centre, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK; danielgaya{at}aol.com

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A 36 year old female patient was reviewed at the gastrointestinal clinic. She had, since the age of 15 years, been affected by troublesome orofacial granulomatosis (OFG) manifest as lower lip swelling together with a midline fissure. In the past she had received numerous therapies, including intralesional and systemic corticosteroid (short term benefit only), cinnamon and a benzoate free diet (lack of compliance), azathioprine (intolerance), and topical tacrolimus (ineffective).

In 2001, due to increasing distress about her appearance compounded by her forthcoming wedding, we decided to treat her with an infliximab infusion at 5 mg/kg. Within seven days there was a noticeable improvement, followed by complete healing of her labial fissure six weeks later, just prior to her wedding. Two weeks after this she found out she was pregnant. She subsequently gave birth to a healthy baby boy …

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