title: Severe Henoch-Schönlein purpura with infliximab for ulcerative colitis.
abstract: Infliximab (IFX) is an anti-tumor necrosis factor chimeric antibody that is effective for treatment of autoimmune disorders such as Crohn's disease and ulcerative colitis (UC). IFX is well tolerated with a low incidence of adverse effects such as infections, skin reactions, autoimmunity, and malignancy. Dermatological manifestations can appear as infusion reaction, vasculitis, cutaneous infections, psoriasis, eczema, and skin cancer. Here, we present an unusual case of extensive and sporadic subcutaneous ecchymosis in a 69-year-old woman with severe UC, partial colectomy and cecostomy, following her initial dose of IFX. The reaction occurred during infliximab infusion, and withdrawal of IFX led to gradual alleviation of her symptoms. We concluded that Henoch-Schönlein purpura, a kind of leukocytoclastic vasculitis, might have contributed to the development of the bruising. Although the precise mechanisms of the vasculitis are still controversial, such a case highlights the importance of subcutaneous adverse effects in the management of UC with IFX.
authors.affiliation: Yang Song, Yan-Hong Shi, Chong He, Chang-Qin Liu, Jun-Shan Wang, Yu-Jie Zhao, Yan-Min Guo, Rui-Jin Wu, Xiao-Yue Feng, Zhan-Ju Liu, Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Song
authors.affiliation: Yang Song, Yan-Hong Shi, Chong He, Chang-Qin Liu, Jun-Shan Wang, Yu-Jie Zhao, Yan-Min Guo, Rui-Jin Wu, Xiao-Yue Feng, Zhan-Ju Liu, Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
authors.forename: Yan-Hong
authors.initials: YH
authors.lastname: Shi
authors.affiliation: Yang Song, Yan-Hong Shi, Chong He, Chang-Qin Liu, Jun-Shan Wang, Yu-Jie Zhao, Yan-Min Guo, Rui-Jin Wu, Xiao-Yue Feng, Zhan-Ju Liu, Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
authors.forename: Chong
authors.initials: C
authors.lastname: He
authors.affiliation: Yang Song, Yan-Hong Shi, Chong He, Chang-Qin Liu, Jun-Shan Wang, Yu-Jie Zhao, Yan-Min Guo, Rui-Jin Wu, Xiao-Yue Feng, Zhan-Ju Liu, Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
authors.forename: Chang-Qin
authors.initials: CQ
authors.lastname: Liu
authors.affiliation: Yang Song, Yan-Hong Shi, Chong He, Chang-Qin Liu, Jun-Shan Wang, Yu-Jie Zhao, Yan-Min Guo, Rui-Jin Wu, Xiao-Yue Feng, Zhan-Ju Liu, Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
authors.forename: Jun-Shan
authors.initials: JS
authors.lastname: Wang
authors.affiliation: Yang Song, Yan-Hong Shi, Chong He, Chang-Qin Liu, Jun-Shan Wang, Yu-Jie Zhao, Yan-Min Guo, Rui-Jin Wu, Xiao-Yue Feng, Zhan-Ju Liu, Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
authors.forename: Yu-Jie
authors.initials: YJ
authors.lastname: Zhao
authors.affiliation: Yang Song, Yan-Hong Shi, Chong He, Chang-Qin Liu, Jun-Shan Wang, Yu-Jie Zhao, Yan-Min Guo, Rui-Jin Wu, Xiao-Yue Feng, Zhan-Ju Liu, Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
authors.forename: Yan-Min
authors.initials: YM
authors.lastname: Guo
authors.affiliation: Yang Song, Yan-Hong Shi, Chong He, Chang-Qin Liu, Jun-Shan Wang, Yu-Jie Zhao, Yan-Min Guo, Rui-Jin Wu, Xiao-Yue Feng, Zhan-Ju Liu, Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
authors.forename: Rui-Jin
authors.initials: RJ
authors.lastname: Wu
authors.affiliation: Yang Song, Yan-Hong Shi, Chong He, Chang-Qin Liu, Jun-Shan Wang, Yu-Jie Zhao, Yan-Min Guo, Rui-Jin Wu, Xiao-Yue Feng, Zhan-Ju Liu, Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
authors.forename: Xiao-Yue
authors.initials: XY
authors.lastname: Feng
authors.affiliation: Yang Song, Yan-Hong Shi, Chong He, Chang-Qin Liu, Jun-Shan Wang, Yu-Jie Zhao, Yan-Min Guo, Rui-Jin Wu, Xiao-Yue Feng, Zhan-Ju Liu, Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
authors.forename: Zhan-Ju
authors.initials: ZJ
authors.lastname: Liu
mesh_terms: D000368:Aged; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D003113:Colonoscopy; D003288:Contusions / Q000139:chemically induced; D004438:Ecchymosis / Q000139:chemically induced; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D000069285:Infliximab / Q000009:adverse effects*; D011398:Promethazine / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D011398:Promethazine
keywords: Henoch-Schönlein purpura; Infliximab; Subcutaneous ecchymosis; Ulcerative colitis; Vasculitis