Superficial abdominal thrombophlebitis (Mondor's disease) presenting as loss of response to adalimumab in a Crohn's disease patient

Dear Editor, Multiple etiologies should be considered in Crohn's disease (CD) patients experiencing worsening symptoms while treated with anti-TNFs.1 We describe an unusual case of seeming loss of response to adalimumab. A 39 year-old man was hospitalized due to worsening right lower abdominal pain lasting for three days prior to presentation. The patient was inflicted by fibro-stenotic Crohn's ileo-colitis for the last three years. He has been treated during the last two years by adalimumab 40 mg bi-weekly, and 6-mercaptopurine at 1.3 mg/kg. The patient underwent four endoscopic balloon dilations of 2 colonic strictures during the course of his disease, but has enjoyed near complete remission in the prior eleven months with a Harvey–Bradshaw index of 4 …