Grillo TG, Almeida LR, Beraldo RF, Marcondes MB, Queiróz DAR, da Silva DL, Quera R, Baima JP, Saad-Hossne R, Sassaki LY. Heart failure as an adverse effect of infliximab for Crohn's disease: A case report and review of the literature. World J Clin Cases 2021; 9(33): 10382-10391 [PMID: 34904114 DOI: 10.12998/wjcc.v9.i33.10382]
Corresponding Author of This Article
Thais Gagno Grillo, MD, Medical Assistant, Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu 18618687, São Paulo, Brazil. thaisgagno@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
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/
World J Clin Cases. Nov 26, 2021; 9(33): 10382-10391 Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10382
Heart failure as an adverse effect of infliximab for Crohn's disease: A case report and review of the literature
Thais Gagno Grillo, Luciana Rocha Almeida, Rodrigo Fedatto Beraldo, Mariana Barros Marcondes, Diego Aparecido Rios Queiróz, Daniel Luiz da Silva, Rodrigo Quera, Julio Pinheiro Baima, Rogerio Saad-Hossne, Ligia Yukie Sassaki
Thais Gagno Grillo, Luciana Rocha Almeida, Rodrigo Fedatto Beraldo, Mariana Barros Marcondes, Diego Aparecido Rios Queiróz, Julio Pinheiro Baima, Rogerio Saad-Hossne, Ligia Yukie Sassaki, Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu 18618687, São Paulo, Brazil
Daniel Luiz da Silva, Department of Pathology, São Paulo State University (Unesp), Medical School, Botucatu 18618687, São Paulo, Brazil
Rodrigo Quera, Inflammatory Bowel Disease Program, Digestive Disease Center Clínica Universidad de los Andes, Santiago 7550000, Chile
Author contributions: All authors contributed to this manuscript; Grillo TG, Almeida LR, Beraldo RF, Marcondes MB, Queiróz DAR, Baima JP, Saad-Hossne R, and Sassaki LY contributed to the conception and design of the study, acquisition, analysis, and interpretation of the data, drafting the article, revising it critically for important intellectual content, and final approval of the version to be submitted; da Silva DL contributed to the description of the histopathological findings, critically reviewing the important intellectual content, and final approval of the version to be submitted; Quera R contributed to the analysis and interpretation of the data, revising the manuscript critically for important intellectual content, and final approval of the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors state that they have no conflicts of interest regarding this case report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) statement, and the manuscript was prepared and revised according to the CARE Statement-checklist of items.
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: Thais Gagno Grillo, MD, Medical Assistant, Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu 18618687, São Paulo, Brazil. thaisgagno@gmail.com
Received: July 11, 2021 Peer-review started: July 11, 2021 First decision: July 26, 2021 Revised: August 8, 2021 Accepted: September 8, 2021 Article in press: September 8, 2021 Published online: November 26, 2021 Processing time: 133 Days and 14.4 Hours
Abstract
BACKGROUND
Anti-tumor necrosis factor agents were the first biologic therapy approved for the management of Crohn's disease (CD). Heart failure (HF) is a rare but potential adverse effect of these medications. The objective of this report is to describe a patient with CD who developed HF after the use of infliximab.
CASE SUMMARY
A 50-year-old woman with a history of hypertension and diabetes presented with abdominal pain, diarrhea, and weight loss. Colonoscopy and enterotomography showed ulcerations, areas of stenosis and dilation in the terminal ileum, and thickening of the intestinal wall. The patient underwent ileocolectomy and the surgical specimen confirmed the diagnosis of stenosing CD. The patient started infliximab and azathioprine treatment to prevent post-surgical recurrence. At 6 mo after initiating infliximab therapy, the patient complained of dyspnea, orthopnea, and paroxysmal nocturnal dyspnea that gradually worsened. Echocardiography revealed biventricular dysfunction, moderate cardiac insufficiency, an ejection fraction of 36%, and moderate pericardial effusion, consistent with HF. The cardiac disease was considered an infliximab adverse effect and the drug was discontinued. The patient received treatment with diuretics for HF and showed improvement of symptoms and cardiac function. Currently, the patient is using anti-interleukin for CD and is asymptomatic.
CONCLUSION
This reported case supports the need to investigate risk factors for HF in inflammatory bowel disease patients and to consider the risk-benefit of introducing infliximab therapy in such patients presenting with HF risk factors.
Core Tip: Anti-tumor necrosis factor agents were the first biologic therapy approved for the management of Crohn's disease (CD). While rare, heart failure (HF) is a potential adverse effect of these medications. In this report we describe a patient with CD who developed HF after treatment with infliximab. The clinical, diagnosis, imaging, and treatment details are all provided and discussed in this case report. This reported case supports the need to investigate risk factors for HF in inflammatory bowel disease patients and to consider the risk-benefit of introducing infliximab therapy in such patients presenting with HF risk factors.
