Beigel Florian, Jürgens Matthias, Filik Levent, Bader Lutz, Lück Christian, Göke Burkhard, Ochsenkühn Thomas, Brand Stephan, Seiderer Julia
Department of Medicine II, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Germany.
Inflamm Bowel Dis. 2009 Aug;15(8):1240-4. doi: 10.1002/ibd.20866.
Immunosuppressive therapy with anti-TNF-alpha antibodies is effective in patients with inflammatory bowel disease (IBD). However, there is an increased risk for infections associated with this therapy.
Here, we report the case of a 58-year-old patient with Crohn's disease (CD) treated with steroids and azathioprine who developed severe Legionella pneumophila pneumonia after 3 infusions of infliximab. The patient presented at our IBD department with severe active CD complicated by inflammatory small bowel stenoses and entero-enteral fistulas despite long-term high-dose steroid therapy. To achieve steroid tapering and control of disease activity, immunosuppressive therapy with azathioprine was initiated. Due to persistent symptoms, infusion therapy with the anti-TNF-alpha antibody infliximab was started, subsequently leading to significant clinical improvement. However, after the third infliximab infusion the patient was hospitalized with fever, severe fatigue, and syncope.
Laboratory findings and chest X-ray revealed left-sided pneumonia; cultural analysis showed L. pneumophila serogroup 1 leading to respiratory insufficiency, which required mechanical ventilation for 2 weeks in the intensive care unit. After discontinuation of all immunosuppressive agents and immediate antibiotic therapy the patient recovered completely.
To our knowledge, this is the third case of L. pneumophila pneumonia in an IBD patient treated with infliximab. Similar to other published cases, concomitant treatment of immunosuppressives and anti-TNF agents is a major risk factor for the development of L. pneumophila infection, which should be ruled out in all cases of pneumonia in patients with such a therapeutic regimen. Appropriate prevention strategies should be provided in these patients.
使用抗TNF-α抗体的免疫抑制疗法对炎症性肠病（IBD）患者有效。然而，这种疗法会增加感染风险。
在此，我们报告一例58岁克罗恩病（CD）患者的病例，该患者接受类固醇和硫唑嘌呤治疗，在输注3次英夫利昔单抗后发生严重嗜肺军团菌肺炎。尽管长期接受高剂量类固醇治疗，但该患者因严重活动性CD合并炎症性小肠狭窄和肠-肠瘘而就诊于我们的IBD科室。为了逐渐减少类固醇用量并控制疾病活动，开始使用硫唑嘌呤进行免疫抑制治疗。由于症状持续，开始使用抗TNF-α抗体英夫利昔单抗进行输注治疗，随后临床症状显著改善。然而，在第三次输注英夫利昔单抗后，患者因发热、严重疲劳和晕厥入院。
实验室检查结果和胸部X线显示左侧肺炎；培养分析显示嗜肺军团菌血清型1导致呼吸功能不全，患者在重症监护病房需要机械通气2周。停用所有免疫抑制剂并立即进行抗生素治疗后，患者完全康复。
据我们所知，这是第三例接受英夫利昔单抗治疗的IBD患者发生嗜肺军团菌肺炎的病例。与其他已发表的病例类似，免疫抑制剂和抗TNF药物的联合治疗是发生嗜肺军团菌感染的主要危险因素，在接受这种治疗方案的患者发生的所有肺炎病例中均应排除该因素。应为这些患者提供适当的预防策略。
