A 34-year-old male with Crohn’s disease (CD) (A2-L3-B3) and bad prognostic criteria at diagnosis, was treated with a “top down” strategy with infliximab and azathioprine, with clinical remission but focal endoscopic activity. After 3 years, a toxidermic reaction to infliximab led to its suspension. On azathioprine monotherapy for 6 months, a severe exacerbation occurred and adalimumab was added.