A 53-year-old man with dyspnoea, respiratory failure, consistent with infliximab-induced acute interstitial pneumonitis after an accelerated induction dosing schedule

• Published in: BMJ case reports Vol. 2017; p. bcr-2017-219956
• Main Authors: Rofaiel, Rymon, Kohli, Sonny, Mura, Marco, Hosseini-Moghaddam, Seyed M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 12.05.2017; BMJ Case Reports
• Series: Case Report
• Subjects: Colitis, Ulcerative - complications; Colitis, Ulcerative - drug therapy; Cytomegalovirus; Diagnosis, Differential; Drug Administration Schedule; Drug dosages; Dyspnea; Dyspnea - etiology; Fatal Outcome; Gastroenterology; Gastrointestinal Agents - administration & dosage; Gastrointestinal Agents - adverse effects; Hemoglobin; Humans; Immune system; Indian sub-continent; Infections; Inflammatory bowel disease; Infliximab - administration & dosage; Infliximab - adverse effects; Lung diseases; Lung Diseases, Interstitial - chemically induced; Lung Diseases, Interstitial - complications; Lung Diseases, Interstitial - diagnosis; Lung Diseases, Interstitial - diagnostic imaging; Male; Middle Aged; Patients; Respiratory Insufficiency - chemically induced; Respiratory Insufficiency - complications; Respiratory Insufficiency - diagnosis; Steroids; Surgery; Tuberculosis; Tumor necrosis factor-TNF; Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions; USA/Canada; Interstitial lung disease; Mechanical ventilation; Respiratory system; Ulcerative colitis
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2017-219956

A 53-year-old man with ulcerative colitis (UC) suffered fatal acute interstitial pneumonitis (AIP) post completing an accelerated infliximab induction course. This is the first case reported in this setting. A literature review found four similar cases of infliximab-induced interstitial lung disease in the setting of treating patients with UC using standard infliximab regimens had successful treatment of the subjects post infliximab discontinuation. Unfortunately, the patient we are presenting, who had an accelerated infliximab induction course, did not survive. Although a prior small trial along more recent new small studies continue to show a benefit in reducing the need for early colectomy with the accelerated infliximab induction regimen as salvage therapy, it should be used cautiously until more safety data are available. Further larger trials are required to investigate rare side effects that may be associated with this regimen such as rapidly progressive lung toxicity as seen in this patient.