Zhang Jie, Liu Mei-Hong, Gao Xue, Dong Chang, Li Yan-Xia
Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China.
Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China.
World J Clin Cases. 2022 Feb 16;10(5):1716-1722. doi: 10.12998/wjcc.v10.i5.1716.
Vedolizumab, a newer class of integrin antagonist biological agents, has been applied to treat patients with moderate-to-severe Crohn's disease (CD) and ulcerative colitis (UC), especially for patients who are refractory to traditional therapies and tumor necrosis factor antagonists. However, some rare but life-threatening adverse effects warrant pharmacovigilance. We describe the first fatal case of vedolizumab-associated severe diffuse interstitial lung disease in China.
We present a case of new-onset diffuse parenchymal lung disease developing under treatment with vedolizumab in a patient with UC. After two doses of vedolizumab, he developed persistent fever and progressively worsening dyspnea. Extensive workups, including bronchoalveolar lavage, transbronchial lung biopsy and metagenomic next-generation sequencing, identified no infectious causes, and other potential causes (such as tumors and cardiogenic pulmonary edema) were also excluded. As a result, a diagnosis of vedolizumab-related interstitial lung disease was established. Unfortunately, although corticosteroids and empiric antibiotics were administered, the patient eventually died of respiratory failure.
Vedolizumab-related interstitial lung disease in patients with UC is rare but potentially lethal. Gastroenterologists and pulmonologists should be aware of vedolizumab-related adverse drug reactions.
维多珠单抗是一种新型的整合素拮抗剂生物制剂，已被应用于治疗中重度克罗恩病（CD）和溃疡性结肠炎（UC）患者，尤其是对传统疗法和肿瘤坏死因子拮抗剂难治的患者。然而，一些罕见但危及生命的不良反应需要进行药物警戒。我们报道了中国首例维多珠单抗相关的严重弥漫性间质性肺病致死病例。
我们报告1例接受维多珠单抗治疗的UC患者出现新发弥漫性实质性肺病的病例。在使用两剂维多珠单抗后，患者出现持续发热和进行性加重的呼吸困难。包括支气管肺泡灌洗、经支气管肺活检和宏基因组下一代测序在内的广泛检查未发现感染原因，其他潜在原因（如肿瘤和心源性肺水肿）也被排除。因此，确诊为维多珠单抗相关的间质性肺病。不幸的是，尽管给予了皮质类固醇和经验性抗生素治疗，患者最终死于呼吸衰竭。
UC患者中维多珠单抗相关的间质性肺病罕见但可能致命。胃肠病学家和肺科医生应了解维多珠单抗相关的药物不良反应。
