Treatment of Fistulas with Granulocyte Colony-Stimulating Factor in a Patient with Crohn's Disease

To the Editor: An adolescent boy with Crohn's disease and enterocutaneous fistulas had a response to treatment with granulocyte colony-stimulating factor (filgrastim) after all standard treatments had failed. The patient presented at the age of eight years with swollen lips. Biopsies of the tongue and oral mucosa showed a chronic inflammatory-cell infiltrate and noncaseating granulomas — findings consistent with the presence of Crohn's disease. At the age of 14 years, rectal inflammation and a perianal fistula developed. The boy had a response to treatment with prednisolone and metronidazole, but the perianal pain recurred when the prednisolone was discontinued. He was . . .