CLINICAL REMISSION OF CROHN'S DISEASE AND RECTOVAGINAL FISTULA CLOSURE FOLLOWING AUTOLOGOUS NON-MYELOABLATIVE HEMATOPOIETIC STEM CELL TRANSPLANTATION: A CASE REPORT

Abstract

Background: Crohn's Disease is a persistent, diverse, and recurring inflammatory bowel condition that can impact any segment of the digestive tract. Currently, there is no known cure for this illness. Clinical management focuses on restoring equilibrium and preventing the frequent flare-ups typical of this immune-mediated disorder that disrupts intestinal function. Treatment strategies include anti-inflammatory drugs, corticosteroids, immunosuppressants, and immunobiologics. However, management is frequently accompanied by relapses two years later independent of the type of procedure and many patients experience complications such as obstructions, strictures, and intestinal fistulas, often necessitating repeated surgical interventions. Anal or perianal fistulas are common, while rectovaginal fistulas present particularly challenging and complex management issues. Case presentation: A 31-year-old patient with a decade-long history of active Crohn's Disease had several unsuccessful perianal surgeries to treat a complex rectovaginal fistula. Due to rectal stenosis, most stools and gases passed through her vagina. Although rectal amputation and a permanent colostomy were advised, the patient declined and opted for a non-myeloablative autologous hematopoietic stem cell transplantation. Two and a half years later, she remains disease-free, with normal bowel movements and no gas or stools passing through her vagina. No previous cases of rectovaginal fistula closure using hematopoietic stem cell transplantation have been recorded. Conclusion: Hematopoietic stem cell transplantation is an alternative procedure for some patients, especially those with severe disease that is refractory to conventional treatments who decline radical surgery. Having a fistula does not preclude transplantation. In the present case, the procedure led to gradual improvement of the rectovaginal fistula, culminating in complete resolution two and a half years post-transplant. The patient remains in remission.