Hirschmann Simon, Fischer Sarah, Klenske Entcho, Dechant Katharina, Distler Jörg H W, Treutlein Christoph, Neurath Markus F, Atreya Raja
Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Germany.
Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany.
Therap Adv Gastroenterol. 2021 Sep 29;14:17562848211044033. doi: 10.1177/17562848211044033. eCollection 2021.
Anti-tumor necrosis factor (TNF) antibodies have become an indispensable part in the therapeutic landscape of treating inflammatory bowel disease (IBD) patients. Nevertheless, they can be associated with the occurrence of severe systemic side effects. Here, we report the case of a 23-year-old patient with ileocolonic Crohn's disease in endoscopic remission under ongoing anti-TNF infliximab therapy with occurrence of novel generalized arthralgia, pleuritic chest pain, and dyspnea. Clinical, laboratory, and imaging diagnostic workup in an extended clinical routine setting at the University Hospital of Erlangen, Germany, was used by a multidisciplinary team consisting of gastroenterologists, radiologists, cardiologists, and rheumatologists to investigate the underlying cause of the clinical symptoms in the patient. The results received using the aforementioned diagnostic setup led to the diagnosis of severe constrictive perimyocarditis due to infliximab-induced lupus-like syndrome with distinct ANA reactivity and elevated anti-dsDNA levels. Furthermore, pronounced ischemic hepatitis was diagnosed. Infliximab treatment was immediately stopped, and initiated corticosteroid pulse therapy only led to partial response as it had to be reduced due to pronounced psychiatric side effects. Persistent signs of pericarditis required additional ibuprofen therapy, which led to subsequent resolution of cardial symptoms. Formerly elevated liver enzymes returned to normal, and there were no clinical signs of recurrence of Crohn's disease activity over 18 months of follow-up. The patient was subsequently switched to ustekinumab therapy for further treatment of underlying Crohn's disease. This case report describes for the first time severe infliximab-induced lupus-like syndrome in an IBD patient, concurrently mimicking ST-elevation myocardial infarction with MRI visualization of pericarditis, occurrence of ischemic hepatitis, and pronounced signs of systemic inflammation.
抗肿瘤坏死因子（TNF）抗体已成为治疗炎症性肠病（IBD）患者治疗方案中不可或缺的一部分。然而，它们可能与严重的全身性副作用的发生有关。在此，我们报告一例23岁患有回结肠克罗恩病的患者，在内镜检查缓解期接受英夫利昔单抗抗TNF治疗期间，出现了新的全身性关节痛、胸膜炎性胸痛和呼吸困难。德国埃尔朗根大学医院在常规临床环境中进行了临床、实验室和影像学诊断检查，由胃肠病学家、放射科医生、心脏病学家和风湿病学家组成的多学科团队对该患者临床症状的潜在原因进行了调查。使用上述诊断方法得出的结果诊断为严重的缩窄性心包炎，原因是英夫利昔单抗诱导的狼疮样综合征，伴有明显的抗核抗体反应性和抗双链DNA水平升高。此外，还诊断出明显的缺血性肝炎。英夫利昔单抗治疗立即停止，开始的皮质类固醇脉冲疗法仅产生部分反应，因为由于明显的精神副作用不得不减少剂量。心包炎的持续体征需要额外的布洛芬治疗，这导致心脏症状随后得到缓解。先前升高的肝酶恢复正常，在18个月的随访中没有克罗恩病活动复发的临床迹象。该患者随后改用优特克单抗治疗潜在的克罗恩病。本病例报告首次描述了IBD患者中严重的英夫利昔单抗诱导的狼疮样综合征，同时通过MRI显示心包炎模拟ST段抬高型心肌梗死、出现缺血性肝炎以及明显的全身炎症体征。
