Adalimumab-induced interstitial pneumonia in a patient with Crohn’s disease

Abstract

There are several reports of anti-tumor necrosis factor (TNF)-induced lung disease, especially in patients with rheumatologic diseases. Adalimumab is an anti-TNF drug used to induce and maintain remission in patients with immune-mediated diseases, such as Crohn’s disease. Although pulmonary disorders could be an extra-intestinal manifestation of inflammatory bowel disease, biologic therapy could also be a cause of lung injury. Only few cases of adalimumab-induced lung toxicity have been reported, and the majority of them were in patients with rheumatologic diseases. Lung injury secondary to anti-TNF therapy should, after ruling out other etiologies, be considered in patients who have a temporal association between the onset of respiratory symptoms and the exposure to these drugs. A compatible pattern in the biopsy and the clinical improvement after discontinuation of the anti-TNF drug would strongly support the diagnosis.

Keywords: Adalimumab; Anti-tumor necrosis factor; Crohn’s disease; Interstitial pneumonia

Core tip: Lung injury secondary to anti-tumor necrosis factor (TNF) drugs could cause severe respiratory symptoms in patients exposed to this therapy, and it should be suspected in patients who: have a temporal association between the onset of respiratory symptoms and the exposure to anti-TNF drugs, show a compatible pattern in the biopsy, and offer negative results for infection. There are a few cases reported of adalimumab-lung toxicity in patients with inflammatory bowel disease. Clinical improvement after biologic therapy discontinuation strongly supports the diagnosis. The mechanism by which anti-TNF drugs induce lung injury remains unclear; therefore, the use of another anti-TNF drug should be discouraged.