I would expert opinion on a clinical issue. 17 year boy diagnosed with CD when presented with history of recurrent oral ulcers, scrotal ulcer, mild iron deficiency and abdominal pain of near 1 year duration. He was started on Azathioprine, Pentasa. The scrotal ulcer and abdominal pain has improved the CRP came down from 60 to 10 and calprotectin came down from 600 to 70. The issue is the oral ulcers are persistent. The boy is based in Abu Dhabi but he is of Indian origin. He could not tolerate oral budesonide. I am confused on what add to control the oral ulcers. I was planning to start on infliximab but the improvement in the parameters and other symptoms without infliximab has confused me. Which may be a safer alternative to infliximab which will help with oral ulcers. I would like get an expert opinion.
Thanks Dr Arun Korah Gastroenterologist NMC Hospital, Abu Dhabi