Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital and Medical Center, Omaha, NE, USA.
Am J Case Rep. 2021 May 25;22:e929892. doi: 10.12659/AJCR.929892.
BACKGROUND Anti-TNF-alpha therapies were the first class of biologics to be used in treatment of moderate to severe IBD. Immunosuppression status that develops from using anti-TNF-a therapies increases the risk of serious and opportunistic infections. We present here a rare case of serious infection that developed in an IBD patient while on anti-TNF therapy. CASE REPORT Our patient was a 14-year-old boy with a history of chronic sinusitis and ulcerative colitis who had been on infliximab therapy for the last 3 years. He presented with facial swelling and worsening constant frontal headache. Imaging showed frontal scalp subgaleal abscess, mild frontal calvarial early osteomyelitis, bilateral preseptal cellulitis, and acute and chronic paranasal sinus disease. He was treated with intravenous antibiotics and underwent sinus surgery with incision and drainage of the forehead abscess. He recovered well and resumed his infliximab infusions 3 weeks after the surgery. CONCLUSIONS PPT is a serious complication of untreated sinusitis. IBD patients on biologics can have higher risk of developing such complications because of their decreased ability to fight infections. Although the risk of serious infections declines significantly after the first year of using biologics, physicians should keep a low threshold for investigating symptomatic patients for serious infections, as they require prompt intervention. Despite the potential complications from using biologics, the benefits of this therapy in IBD patients outweigh the risks.
抗 TNF-α 治疗是治疗中重度 IBD 的第一批生物制剂。使用抗 TNF-a 治疗引起的免疫抑制状态会增加严重和机会性感染的风险。我们在此报告一例在接受抗 TNF 治疗的 IBD 患者中发生的严重感染病例。
我们的患者是一名 14 岁男孩，有慢性鼻窦炎和溃疡性结肠炎病史，过去 3 年一直在接受英夫利昔单抗治疗。他出现面部肿胀和持续的额头痛加剧。影像学显示额头皮下脓肿、轻度额骨早期骨髓炎、双侧眶隔蜂窝织炎以及急性和慢性副鼻窦炎疾病。他接受了静脉内抗生素治疗，并进行了鼻窦手术，切开并引流额部脓肿。他恢复良好，在手术后 3 周恢复了英夫利昔单抗输注。
PPT 是未经治疗的鼻窦炎的严重并发症。由于生物制剂治疗的患者抗感染能力下降，他们发生此类并发症的风险更高。尽管在使用生物制剂后的第一年，严重感染的风险显著下降，但医生应该对有症状的患者进行严重感染的调查保持低门槛，因为它们需要及时干预。尽管使用生物制剂存在潜在并发症，但这种治疗在 IBD 患者中的益处大于风险。
