Noninfectious interstitial lung disease during infliximab therapy: Case report and literature review

Abstract

Pulmonary abnormalities are not frequently encountered in patients with inflammatory bowel diseases. However, lung toxicity can be induced by conventional medications used to maintain remission, and similar evidence is also emerging for biologics. We present the case of a young woman affected by colonic Crohn’s disease who was treated with oral mesalamine and became steroid-dependent and refractory to azathioprine and adalimumab. She was referred to our clinic with a severe relapse and was treated with infliximab, an anti-tumor necrosis factor α (TNF-α) antibody, to induce remission. After an initial benefit, with decreases in bowel movements, rectal bleeding and C-reactive protein levels, she experienced shortness of breath after the 5^th infusion. Noninfectious interstitial lung disease was diagnosed. Both mesalamine and infliximab were discontinued, and steroids were introduced with slow but progressive improvement of symptoms, radiology and functional tests. This represents a rare case of interstitial lung disease associated with infliximab therapy and the effect of drug withdrawal on these lung alterations. Given the increasing use of anti-TNF-α therapies and the increasing reports of pulmonary abnormalities in patients with inflammatory bowel diseases, this case underlines the importance of a careful evaluation of respiratory symptoms in patients undergoing infliximab therapy.

Keywords: Interstitial lung disease, Crohn’s disease, Infliximab, Mesalamine, Drug-induced toxicity

Core tip: Safety during anti-tumor necrosis factor (TNF)-α therapy is a major concern. Paradoxical inflammatory and autoimmune phenomena can be induced by this treatment and should always be considered. Interstitial lung disease is an emerging complication often observed early after the beginning of treatment, particularly when combination immunosuppressive regimens are employed. This case demonstrates that interstitial lung disease can also occur later during anti-TNF-α treatment and during monotherapy. Thus, great vigilance is recommended when patients start complaining of any respiratory symptom.