title: Noninfectious interstitial lung disease during infliximab therapy: case report and literature review.
abstract: Pulmonary abnormalities are not frequently encountered in patients with inflammatory bowel diseases. However, lung toxicity can be induced by conventional medications used to maintain remission, and similar evidence is also emerging for biologics. We present the case of a young woman affected by colonic Crohn's disease who was treated with oral mesalamine and became steroid-dependent and refractory to azathioprine and adalimumab. She was referred to our clinic with a severe relapse and was treated with infliximab, an anti-tumor necrosis factor α (TNF-α) antibody, to induce remission. After an initial benefit, with decreases in bowel movements, rectal bleeding and C-reactive protein levels, she experienced shortness of breath after the 5(th) infusion. Noninfectious interstitial lung disease was diagnosed. Both mesalamine and infliximab were discontinued, and steroids were introduced with slow but progressive improvement of symptoms, radiology and functional tests. This represents a rare case of interstitial lung disease associated with infliximab therapy and the effect of drug withdrawal on these lung alterations. Given the increasing use of anti-TNF-α therapies and the increasing reports of pulmonary abnormalities in patients with inflammatory bowel diseases, this case underlines the importance of a careful evaluation of respiratory symptoms in patients undergoing infliximab therapy.
authors: Department of Surgical, Oncological and Gastroenterological Sciences, Gastroenterology Section, University of Padova, 35128 Padova, Italy. roberta.caccaro@gmail.com
authors: Roberta
authors: R
authors: Caccaro
authors: Edoardo
authors: E
authors: Savarino
authors: Renata
authors: R
authors: D'Incà
authors: Giacomo Carlo
authors: GC
authors: Sturniolo
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy*; D057915:Drug Substitution; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects*; D006801:Humans; D000069285:Infliximab; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D020127:Recovery of Function; D012129:Respiratory Function Tests; D013256:Steroids / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D013256:Steroids; D000069285:Infliximab
keywords: Crohn’s disease; Drug-induced toxicity; Infliximab; Interstitial lung disease; Mesalamine
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