Gastroenterology Department of Damascus Hospital, Damascus, Syria.
Medicine (Baltimore). 2022 Jan 28;101(4):e28722. doi: 10.1097/MD.0000000000028722.
The ongoing coronavirus pandemic has caused severe acute respiratory syndrome, posing a significant challenge for patients receiving immunotherapy for immune-mediated inflammatory diseases. As of January 2022, immunosuppressants such as tumor necrosis factor inhibitors (anti-TNFα) and azathioprine are inadvisable for an infectious disease caused by the SARS-CoV-2 virus (COVID-19). We continued infliximab as a second induction dose nine days after the onset of COVID-19 symptoms in a patient with acute severe ulcerative colitis.
We report the case of a 34-year-old male with 6 to 8 times bloody diarrhea, fever, and cramping abdominal pain. Ulcerative colitis was diagnosed 6 months earlier and treated with mesalamine 80 mg/kg/day and azathioprine 2.5 mg/kg/day. The patient had never undergone surgery before. Sigmoidoscopy revealed multiple ulcerations and spontaneous bleeding, and the colon samples tested negative for cytomegalovirus and Clostridium difficile. However, intravenous corticosteroids did not induce remission. A nasopharyngeal swab tested positive for SARS-CoV-2.
Acute severe ulcerative colitis and SARS-CoV-2 (COVID-19) pneumonia.
The second loading dose of infliximab was administered nine days after the diagnosis of COVID-19.
The patient completed infliximab induction at a dose of 5 mg/kg at weeks 0, 2, and 6, with no complications.
It is unclear whether anti-TNF-α treatment improves or deteriorates COVID-19 patient outcomes, and this case demonstrates that infliximab can be used safely. Current guidelines make a weak recommendation to avoid using anti-TNFα agents in the presence of acute COVID-19 infection. There is an urgent need for research on biologics therapy.
持续的冠状病毒大流行导致严重急性呼吸系统综合征，这对接受免疫治疗的免疫介导性炎症性疾病患者构成了重大挑战。截至 2022 年 1 月，肿瘤坏死因子抑制剂（抗 TNF-α）和硫唑嘌呤等免疫抑制剂不应用于由 SARS-CoV-2 病毒（COVID-19）引起的传染病。我们在一名患有急性重度溃疡性结肠炎的患者出现 COVID-19 症状九天后继续使用英夫利昔单抗作为二线诱导剂量。
我们报告了一名 34 岁男性的病例，他有 6 至 8 次血性腹泻、发热和痉挛性腹痛。6 个月前诊断为溃疡性结肠炎，给予美沙拉嗪 80mg/kg/天和硫唑嘌呤 2.5mg/kg/天治疗。该患者此前从未接受过手术。乙状结肠镜检查显示多处溃疡和自发性出血，结肠样本检测巨细胞病毒和艰难梭菌均为阴性。然而，静脉注射皮质类固醇并未诱导缓解。鼻咽拭子检测 SARS-CoV-2 呈阳性。
急性重度溃疡性结肠炎和 SARS-CoV-2（COVID-19）肺炎。
在诊断 COVID-19 九天后给予英夫利昔单抗二线诱导剂量。
患者完成了 5mg/kg 的英夫利昔单抗诱导剂量，在第 0、2 和 6 周分别给予 5mg/kg，无并发症。
尚不清楚抗 TNF-α 治疗是否改善或恶化 COVID-19 患者的结局，该病例表明英夫利昔单抗可安全使用。当前指南强烈建议避免在急性 COVID-19 感染时使用抗 TNFα 药物。迫切需要对生物制剂治疗进行研究。
