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We report a case of Crohn's disease in a patient with relapsing-remitting Multiple Sclerosis diagnosed and in treatment at Walter Cantidio Hospital -- UFC -- Fortaleza, state of Ceara, Brazil. N.N.O.A., female, 44 years old, no smoker, started in 1994 sensitive alteration in the legs with sensitive level until T4. She was submitted to investigation and was diagnosed with multiple sclerosis. After 6 years started treatment with immunomodulators, however she had 6 outbreaks and collateral effects, so in 2012 changed treatment to natalizumab, and her EDSS decreased from 2 to zero after 6 pulses. The Crohn's disease was diagnosed in 2002 by biopsy, and started with proctitis, diarrhea and fecal incontinence. Actually, she treats the Crohn's disease with mesalazine. In September of 2008 she had a relapse of the Crohn's disease in concurrence with an outbreak of the multiple sclerosis (MS), and was submitted to pulse with methylprednisolone, improving both diseases. Although MS and inflammatory bowel disease (IBL) may share common predisposing factors, not enough information is available to speculate about possible mechanisms. Concurrence of the 2 diseases is greater than expected, so cases like this may be reported to trace an adequate therapeutic. [ABSTRACT FROM AUTHOR] more...

Fourteen (14) patients living in Fortaleza, state of Ceara, Brazil (3o 43' S and 38o 29'W) are treated with natalizumab for relapsing-remitting or progressive-relapsing Multiple Sclerosis (RRMS). The estimated prevalence of MS in Bazil is around 15 cases for 100.000 inhabitants. The reasons for introducing natalizumab were lack of response or intolerance to first line immunomodulators (interferons beta 1a or beta lb and glatiramer acetate), in many instances associated with the appearance of new, gadolinium-enhancing lesions on brain or spine MRI. Lack of response or treatment failure was defined according to the Brazilian guidelines. The prevalent gender was female (10 patients). Median age of disease onset was 27 years old (range from 7 to 48). Only one patient had less than 8 years of study. Two patients used to smoke at disease onset. Five patients had positive oligoclonal bands, five had negative and four patients didn't need oligoclonal bands to diagnose MS. Twelve patients were negative for JCV and only two were positive. Two patients (14%) were previously treated with mitoxantrone, thus enforcing a 6 month washout period before starting natalizumab. Only one patient didn't use any immunomodulator before starting natalizumab; thirteen used at least one immunomodulator. Six patients improved EDSS after using natalizumab, six didn't change EDSS and two worsened EDSS. Two patients quitted the use of natalizumab; one because JCV was positive and one because EDSS didn't become better. Only five patients had one new outbreak after starting natalizumab and nine patients stopped having outbreaks, showing the effectiveness of the treatment and better life quality of the treated patients, even those who had many outbreaks while using immunomodulators. [ABSTRACT FROM AUTHOR] more...