Is Ustekinumab the best treatment option in patients with Crohn's disease and coexistent multiple sclerosis?

Crohn's Disease (CD) and Multiple Sclerosis (MS) are chronic diseases associated with an aberrant immune response upon an environmental trigger in genetically susceptible hosts. We present the case of a young patient with known MS diagnosed with new onset CD. Due to his young age, extended disease (Montreal A2L1,4B1) and smoking habits he was considered candidate for immunosuppression therapy but developed acute pancreatitis 2 weeks after azathioprine administration. Subsequently, ustekinumab was initiated. The patient showed clinical and biochemical response within the first 2 months of therapy and achieved mucosal healing (Simple Endoscopic Score for Crohn's Disease of 0 compared to 6 at baseline) at 12 months of therapy. No clinical episodes of MS or new lesions on MRI have developed 17 months after treatment commencement.