Li H, Xing H, Hu C, Sun BY, Wang S, Li WY, Qu B. Hemorrhagic pericardial effusion following treatment with infliximab: A case report and literature review . World J Clin Cases 2021; 9(25): 7593-7599 [PMID: 34616831 DOI: 10.12998/wjcc.v9.i25.7593]
Corresponding Author of This Article
Bo Qu, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology, The 2nd Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Harbin 150086, Heilongjiang Province, China. qubo_1970@hotmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hui Li, Hui Xing, Chen Hu, Bai-Yang Sun, Shuang Wang, Wan-Ying Li, Bo Qu, Department of Gastroenterology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
Author contributions: Li H, Hu C, and Qu B were the patient’s gastroenterologists; Xing H was the primary nurse; Li H, Hu C, Qu B, and Xing H reviewed the literature and contributed to the manuscript drafting; Sun BY, Wang S, and Li WY interpreted the imaging findings and contributed to the manuscript drafting; Qu B and Li H were responsible for the revision of the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that there are no any conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo Qu, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology, The 2nd Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Harbin 150086, Heilongjiang Province, China. qubo_1970@hotmail.com
Received: May 6, 2021 Peer-review started: May 6, 2021 First decision: June 6, 2021 Revised: June 16, 2021 Accepted: July 2, 2021 Article in press: July 2, 2021 Published online: September 6, 2021
Abstract
BACKGROUND
Infliximab (IFX) is an anti-tumor necrosis factor alpha (TNF-α) agent that is widely used for the management of a variety of autoimmune and inflammatory diseases, including Crohn's disease (CD). As a result of its increasing administration, new complications have emerged. Hemorrhagic pericardial effusion, secondary to IFX therapy, is a rare but life-threatening complication.
CASE SUMMARY
A 27-year-old man was diagnosed with CD (Montreal A2L3B1) 6 years prior. After failing to respond to mesalazine and methylprednisolone, he took the first dose of IFX 300 mg based on his weight (60 kg, dose 5 mg/kg) on December 3, 2018. He responded well to this therapy. However, on January 21, 2019, 1 wk after the third injection, he suddenly developed dyspnea, fever, and worsening weakness and was admitted to our hospital. On admission, computed tomography scan of the chest revealed a large pericardial effusion and a small right-side pleural effusion. An echocardiogram showed a large pericardial effusion and normal left ventricular function. Then successful ultrasound-guided pericardiocentesis was performed and 600 mL hemorrhagic fluid was drained. There was no evidence of infection and the concentrations of TNF-α, IFX, and anti-IFX antibody were 7.09 pg/mL (reference range < 8.1 pg/mL), < 0.4 μg/mL (> 1.0 μg/mL), and 373 ng/mL (< 30 ng/mL), respectively. As the IFX instruction manual for injection does mention pericardial effusion as a rare adverse reaction (≥ 1/10000, < 1/1000), so we discontinued the IFX. Monitoring of the patient’s echocardiogram for 2 mo without IFX therapy showed no recurrence of hemorrhagic pericardial effusion. Follow-up visits and examinations every 3 to 6 mo until April 2021 showed no recurrence of CD or pericardial effusion.
CONCLUSION
This is a case of hemorrhagic pericardial effusion following treatment with IFX. It is a rare but life-threatening complication of IFX. Early recognition helps prevent the occurrence of hemorrhagic pericardial effusion and minimize the impact on the natural evolution of the disease.
Core Tip: Pericarditis or pericardial effusion is a rare but serious complication of infliximab (IFX), especially cardiac tamponade, and most patients have rheumatoid arthritis and drug-induced lupus erythematosus. This is a case of hemorrhagic pericardial effusion following treatment with IFX. The patient was diagnosed with Crohn's disease. A high titer of anti-IFX antibodies and a strong type III immunologic reaction may be a possible cause. This suggests that clinicians need to pay attention to the occurrence of pericardial effusion in patients treated with IFX. Early recognition helps prevent the occurrence of hemorrhagic pericardial effusion and minimize its impact on the natural evolution of the disease.
