Nasir Syed Alishan, Patel Ronak, Wojkiewicz Steven, Scatena Robyn
Internal Medicine, Norwalk Hospital, Norwalk, USA.
Radiology, Norwalk Hospital, Norwalk, USA.
Cureus. 2022 Dec 28;14(12):e33064. doi: 10.7759/cureus.33064. eCollection 2022 Dec.
Infliximab belongs to the family of tumor necrosis factor (TNF) alpha inhibitors and since its development, it has revolutionized treatment for both rheumatological diseases and inflammatory bowel disease (IBD). In IBD specifically, it has shown to result in symptomatic, endoscopic, and histological remission which is why it is one of the most widely used treatments for moderate to severe IBD. While common side effects include infections due to immunosuppression, cytopenias and hepatotoxicity, interstitial lung disease (ILD) has been infrequently reported to result from inflixiamb use. We present the case of a patient with ulcerative colitis (UC) who achieved remission with infliximab, however, after about two years of infusions, developed evidence of non-specific interstitial pneumonitis (NSIP). Extensive work up was done to rule out infections, mixed connective tissue disorders, and hypersensitivity pneumonitis. Although lung biopsy remains the gold standard for diagnosing NSIP; clinical, laboratory, and radiographic findings were sufficient in establishing this diagnosis. Initiation of empiric high dose steroids, and cessation of infliximab infusions showed improvement in respiratory status and resolution of lung findings. This case highlights the importance of recognizing adverse effects of infliximab on the pulmonary status of an IBD patient given that infliximab mediated ILD does not adhere to a specific timeline. Considering that respiratory function may be compromised post any number of infusions, it is imperative to acknowledge patients' respiratory complaints and initiate prompt investigation and evaluation for this rare complication.
英夫利昔单抗属于肿瘤坏死因子（TNF）α抑制剂家族，自研发以来，它彻底改变了风湿病和炎症性肠病（IBD）的治疗方法。特别是在IBD中，它已被证明能带来症状缓解、内镜改善和组织学缓解，这就是为什么它是中重度IBD最广泛使用的治疗方法之一。常见的副作用包括免疫抑制导致的感染、血细胞减少和肝毒性，而使用英夫利昔单抗导致间质性肺病（ILD）的报道较少。我们报告一例溃疡性结肠炎（UC）患者，使用英夫利昔单抗实现缓解，但在输注约两年后，出现了非特异性间质性肺炎（NSIP）的证据。进行了广泛检查以排除感染、混合性结缔组织病和过敏性肺炎。虽然肺活检仍是诊断NSIP的金标准，但临床、实验室和影像学检查结果足以确诊。开始经验性高剂量类固醇治疗并停止英夫利昔单抗输注后，呼吸状况有所改善，肺部检查结果也得到缓解。该病例突出了认识到英夫利昔单抗对IBD患者肺部状况的不良反应的重要性，因为英夫利昔单抗介导的ILD并不遵循特定的时间线。鉴于任何次数的输注后呼吸功能都可能受损，必须重视患者的呼吸主诉，并对这种罕见并发症进行及时调查和评估。
