{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T04:55:13Z","timestamp":1781585713341,"version":"3.54.5"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Gastroenterol."],"abstract":"<jats:p>Infliximab (IFX) has been a first-line treatment for perianal fistulizing Crohn\u2019s disease (CD) since 1999. However, its role in non-CD-related fistulas remains largely unknown, despite the established involvement of tumor necrosis factor (TNF) in both types of fistulas. A 76-year-old man with a history of prostate cancer presented in 2024 with recurrent fistulas and a presacral wound cavity with sepsis. He had been hospitalized approximately once a month over the past year due to fever and uncontrolled infection. The patient was initially treated with radiation in 2017. Despite this treatment, he developed increasing polyuria related to prostatic hyperplasia, which led to his first operation (prostatectomy) with accidental rectal injury, followed by multiple surgeries for complications and subsequent abscess formation. Histologically, there was no evidence of CD. Due to a lack of surgical options and failed endoscopic treatments, the patient was considered for exploratory IFX therapy. The patient received IFX induction therapy (5 mg\/kg every 2 weeks for the first two doses) in May 2024, followed by maintenance therapy (5 mg\/kg every 8 weeks). Within just 2 weeks, he reported the first significant clinical improvement. After 22 weeks of therapy with IFX, he reported feeling well, with no abdominal pain and a weight gain of 6\u00a0kg. At the 1-year follow-up, no further hospitalizations due to uncontrolled presacral infection with fever and anal pus discharge were reported, and the presacral wound cavity was found to be reduced on MRI from 37\u00a0mm \u00d7 43\u00a0mm \u00d7 62\u00a0mm (March 2024) to 23\u00a0mm \u00d7 22\u00a0mm \u00d7 45\u00a0mm (May 2025). Despite a history of recurrent urinary tract infections (UTIs) associated with mono-J catheters, the frequency of UTIs did not increase during therapy with IFX. This case indicates that infliximab may represent an effective therapeutic option for non-CD-related fistulas when there are no other therapeutic options available.<\/jats:p>","DOI":"10.3389\/fgstr.2026.1815049","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T04:28:12Z","timestamp":1781584092000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Infliximab as ultima ratio in a case of refractory non-Crohn\u2019s disease complex fistula system: case report and mini-review of the literature"],"prefix":"10.3389","volume":"5","author":[{"given":"Nada","family":"Agbariah","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Kis","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Kantonsspital Frauenfeld","place":["Frauenfeld, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Manser","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Kantonsspital Frauenfeld","place":["Frauenfeld, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc","family":"Biedermann","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard","family":"Rogler","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd012623.pub2","article-title":"Infliximab for medical induction of remission in Crohn's disease","volume":"11","author":"Gordon","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/00001610-199911000-00004","article-title":"Anti-TNF alpha: new therapy for Crohn's disease","volume":"22","author":"Mikula","year":"1999","journal-title":"Gastroenterol Nurs"},{"key":"B3","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1007\/s11605-006-0021-y","article-title":"Cytokine network in chronic perianal Crohn's disease and indeterminate colitis after colectomy","volume":"11","author":"Ruffolo","year":"2007","journal-title":"J Gastrointest Surg"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/s0016-5085(08)64131-1","article-title":"Cytokine network in rectal mucosa in perianal Crohn's disease: relations with inflammatory parameters and need for surgery","volume":"14","author":"Ruffolo","year":"2008","journal-title":"Inflammation Bowel Dis"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1056\/nejm199905063401804","article-title":"Infliximab for the treatment of fistulas in patients with Crohn's disease","volume":"340","author":"Present","year":"1999","journal-title":"N Engl J Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1016\/j.cgh.2012.12.042","article-title":"Long-term outcome of perianal fistulizing Crohn's disease treated with infliximab","volume":"11","author":"Bouguen","year":"2013","journal-title":"Clin Gastroenterol Hepatol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v26.i14.1554","article-title":"Optimized timing of using infliximab in perianal fistulizing Crohn's disease","volume":"26","author":"Sun","year":"2020","journal-title":"World J Gastroenterol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1093\/ecco-jcc\/jjz180","article-title":"ECCO guidelines on therapeutics in crohn's disease: medical treatment","volume":"14","author":"Torres","year":"2020","journal-title":"J Crohns Colitis"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2021.04.022","article-title":"AGA clinical practice guidelines on the medical management of moderate to severe luminal and perianal fistulizing crohn's disease","volume":"160","author":"Feuerstein","year":"2021","journal-title":"Gastroenterology"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjw182","article-title":"Association of induction infliximab levels with clinical response in perianal crohn's disease","volume":"11","author":"Davidov","year":"2017","journal-title":"J Crohns Colitis"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2021.07.053","article-title":"Higher anti-tumor necrosis factor-\u03b1 Levels correlate with improved radiologic outcomes in crohn's perianal fistulas","volume":"20","author":"De Gregorio","year":"2022","journal-title":"Clin Gastroenterol Hepatol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13970","article-title":"Higher infliximab trough levels are associated with perianal fistula healing in patients with Crohn's disease","volume":"45","author":"Yarur","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjae190.0056","article-title":"DOP017 Infliximab induction fails to reach targets in Perianal Fistulizing Crohn\u2019s Disease: first results from the ATLANTIC study","volume":"19","author":"Mulders","year":"2025","journal-title":"J Crohn's Colitis"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16741","article-title":"European Society of Coloproctology: Guidelines for diagnosis and treatment of cryptoglandular anal fistula","volume":"26","author":"Reza","year":"2024","journal-title":"Colorectal Dis"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/dcr.0000000000001233","article-title":"Treatment of complicated anal fistula by an endofistular polyurethane-sponge vacuum therapy: A pilot study","volume":"61","author":"Schniewind","year":"2018","journal-title":"Dis Colon Rectum"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.17235\/reed.2024.10847\/2024","article-title":"Endoscopic vacuum therapy for leaky cavities: is it possible","volume":"118","author":"Bas-Cutrina","year":"2024","journal-title":"Rev Esp Enferm Dig"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1055\/a-1662-5028","article-title":"Endoscopic treatment of rectovesical fistula after colorectal anastomosis: tube-in-tube endoscopic vacuum therapy method","volume":"54","author":"de Lima","year":"2022","journal-title":"Endoscopy"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1055\/a-2344-7445","article-title":"Combined endoscopic management of a postoperative rectocutaneous fistula after cystectomy using modified percutaneous endofistular and transanal endoluminal vacuum therapy","volume":"56","author":"Alwali","year":"2024","journal-title":"Endoscopy"},{"key":"B19","article-title":"Time-scheduled dotted and solid thread-ligating therapy combined with vacuum sealing drainage for treating high complex anal fistula","volume":"13","author":"Gao","year":"2021","journal-title":"Am J Transl Res"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-004-0595-3","article-title":"Infliximab as a therapy for non-Crohn's enterocutaneous fistulae","volume":"19","author":"Date","year":"2004","journal-title":"Int J Colorectal Dis"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1177\/03000605231208596","article-title":"Remarkable effects of infliximab on severe radiation-induced side effects in a patient with uterine cervical cancer: a case report","volume":"51","author":"Toft Mor\u00e9n","year":"2023","journal-title":"J Int Med Res"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjz187","article-title":"ECCO guidelines on therapeutics in crohn\u2019s disease: surgical treatment","volume":"18","author":"Adamina","year":"2024","journal-title":"J Crohn's Colitis"},{"key":"B23","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1038\/s41577-022-00792-3","article-title":"Death by TNF: a road to inflammation","volume":"23","author":"van Loo","year":"2023","journal-title":"Nat Rev Immunol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1038\/ctg.2017.33","article-title":"Fistulizing crohn's disease","volume":"8","author":"Scharl","year":"2017","journal-title":"Clin Transl Gastroenterol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1080\/1744666x.2019.1646127","article-title":"Overall and comparative safety of biologic and immunosuppressive therapy in inflammatory bowel diseases","volume":"15","author":"Holmer","year":"2019","journal-title":"Expert Rev Clin Immunol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s10238-025-01738-4","article-title":"Risk of new or recurrent cancer during treatment with biologics in patients with immune-mediated inflammatory diseases and previous cancer: a meta-analysis","volume":"25","author":"Isufi","year":"2025","journal-title":"Clin Exp Med"}],"container-title":["Frontiers in Gastroenterology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgstr.2026.1815049\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T04:28:16Z","timestamp":1781584096000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgstr.2026.1815049\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,16]]},"references-count":26,"alternative-id":["10.3389\/fgstr.2026.1815049"],"URL":"https:\/\/doi.org\/10.3389\/fgstr.2026.1815049","relation":{},"ISSN":["2813-1169"],"issn-type":[{"value":"2813-1169","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,16]]},"article-number":"1815049"}}