Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1716
Peer-review started: October 11, 2021
First decision: November 7, 2021
Revised: December 18, 2021
Accepted: January 5, 2022
Article in press: January 5, 2022
Published online: February 16, 2022
Processing time: 122 Days and 17.8 Hours
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.
Core Tip: Vedolizumab is the treatment of choice for patients with moderate-to-severe ulcerative colitis who are refractory to tumor necrosis factor antagonists. However, some rare but potentially lethal drug-associated adverse effects warrant pharmacovigilance. We present a case of new-onset diffuse parenchymal lung disease development under treatment with vedolizumab in a patient with ulcerative colitis. After two doses of vedolizumab, he developed persistent fever, progressively worsening dyspnea and eventually died of respiratory failure. The patient was eventually diagnosed with vedolizumab-related interstitial lung disease, in spite of the few case reports found after reviewing the literature. We aim to raise gastroenterologists’ and pulmonologists’ vigilance to this uncommon adverse event.