Bilateral Sub-deltoid Bursitis in a Patient Receiving Infliximab for Crohn's Disease

Background: Infiximab has been shown to be effective in inducing and maintaining remission of intestinal bowel diseases. Infiximab has been associated with many adverse events. Articular manifestations are commonly reported, but they are of variable clinical expression and aetiology. Among them, inflammatory bursitis has rarely been described. Objective: Herein a case of inflammatory bursitis in a patient with Crohn’s disease after switching to biosimilar infliximab is reported. Case Report:: A 41-year-old man with Crohn’s disease evolving from 3 years was referred to infliximab therapy at a dose of 5mg/kg because of an aggressive resistant perineal fistula. After 14 infusions of infliximab, the treatment was switched to infliximab biosimilar using the same dose and frequency of administration. Discussion: The diagnosis of non-infective sub-acromial bursitis secondary to infliximab infusion was made as the patient’s symptoms resolved rapidly without any antibiotics. Infliximab was definitively stopped and adalimumab was introduced. : Forty-eight hours after the second infusion, he developed an acute onset of muscle pain and stiffness on both of his shoulders. A musculoskeletal ultrasound was performed and revealed a hypoechoic widening of both subacromial bursae. It was more severe on the left side. Conclusions: Musculoskeletal side effects of infliximab infusion are uncommonly reported. Among them, bursitis has been reported in only a few cases. Ultrasonography can help early diagnosis of bursitis. The time of occurring of this reaction regarding infliximab infusion, screening of Antibodies to Infliximab (ATI) and clinical outcome after drug discontinuation are the main helpful arguments.

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Case report of severe constrictive perimyocarditis and ischemic hepatitis in a Crohn’s disease patient upon infliximab-induced lupus-like syndrome

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211044033 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110440

Author(s):

Simon Hirschmann ◽

Sarah Fischer ◽

Entcho Klenske ◽

Katharina Dechant ◽

Jörg H.W. Distler ◽

...

Keyword(s):

Crohn’S Disease ◽

Case Report ◽

Side Effects ◽

Crohn's Disease ◽

Disease Patient ◽

Clinical Signs ◽

University Hospital ◽

Infliximab Treatment ◽

Ischemic Hepatitis ◽

Elevated Liver Enzymes

Anti-tumor necrosis factor (TNF) antibodies have become an indispensable part in the therapeutic landscape of treating inflammatory bowel disease (IBD) patients. Nevertheless, they can be associated with the occurrence of severe systemic side effects. Here, we report the case of a 23-year-old patient with ileocolonic Crohn’s disease in endoscopic remission under ongoing anti-TNF infliximab therapy with occurrence of novel generalized arthralgia, pleuritic chest pain, and dyspnea. Clinical, laboratory, and imaging diagnostic workup in an extended clinical routine setting at the University Hospital of Erlangen, Germany, was used by a multidisciplinary team consisting of gastroenterologists, radiologists, cardiologists, and rheumatologists to investigate the underlying cause of the clinical symptoms in the patient. The results received using the aforementioned diagnostic setup led to the diagnosis of severe constrictive perimyocarditis due to infliximab-induced lupus-like syndrome with distinct ANA reactivity and elevated anti-dsDNA levels. Furthermore, pronounced ischemic hepatitis was diagnosed. Infliximab treatment was immediately stopped, and initiated corticosteroid pulse therapy only led to partial response as it had to be reduced due to pronounced psychiatric side effects. Persistent signs of pericarditis required additional ibuprofen therapy, which led to subsequent resolution of cardial symptoms. Formerly elevated liver enzymes returned to normal, and there were no clinical signs of recurrence of Crohn’s disease activity over 18 months of follow-up. The patient was subsequently switched to ustekinumab therapy for further treatment of underlying Crohn’s disease. This case report describes for the first time severe infliximab-induced lupus-like syndrome in an IBD patient, concurrently mimicking ST-elevation myocardial infarction with MRI visualization of pericarditis, occurrence of ischemic hepatitis, and pronounced signs of systemic inflammation.

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A case report of Crohn's disease with recto-urethro-perineal fistula.

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.22.1930 ◽

1989 ◽

Vol 22 (7) ◽

pp. 1930-1933

Author(s):

Tetsuya MATSUO ◽

Iwao SASAKI ◽

Yuji FUNAYAMA ◽

Hiroo NAITO ◽

Yasuhiko KAMIYAMA ◽

...

Keyword(s):

Crohn’S Disease ◽

Case Report ◽

Crohn's Disease ◽

Perineal Fistula

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Localization and Activity of Inflammatory Bowel Disease Using 111ln Leukocyte Imaging

Nuklearmedizin ◽

10.1055/s-0038-1629438 ◽

1988 ◽

Vol 27 (03) ◽

pp. 83-86 ◽

Cited By ~ 3

Author(s):

B. Briele ◽

F. Wolf ◽

H. J. Biersack ◽

F. F. Knapp ◽

A. Hotze

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Bowel Disease ◽

Cell Uptake ◽

Disease Extent ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Leukocyte Imaging

A prospective study was initiated to compare the clinically proven results concerning localization/extent and activity of inflammatory bowel diseases with those of 111ln-oxine leukocyte imaging. All patients studied were completely examined with barium enema x-ray, clinical and laboratory investigations, and endoscopy with histopathology. A total of 31 leukocyte scans were performed in 15 patients (12 with Crohn’s disease, 3 with ulcerative colitis). The scans were graded by comparing the cell uptake of a lesion (when present) and a bone marrow area providing a count ratio (CR). The inflammatory lesions were correctly localized on 26 leukocyte scans, and in 21 scans the scintigraphically estimated extent of disease was identical to endoscopy. In 5 cases the disease extent was underestimated, 4 scans in patients with relapse of Crohn’s disease were falsely negative, and in one patient with remission truly negative. The scintigraphically assessed disease activity was also in a good agreement with clinical disease activity based on histopathology in all cases. We conclude that leukocyte imaging provides valuable information about localization and activity of inflammatory bowel disease.

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Long-term management of resistant, fistulazing Crohn's disease by ongoing 4-weekly infliximab therapy (a case report)

Zeitschrift für Gastroenterologie ◽

10.1055/s-2005-869761 ◽

2005 ◽

Vol 43 (05) ◽

Author(s):

R Schwab ◽

P Lakatos ◽

E Schäfer ◽

J Weltner ◽

A Sáfrány ◽

...

Keyword(s):

Crohn’S Disease ◽

Case Report ◽

Crohn's Disease ◽

Infliximab Therapy ◽

Term Management

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Metastatic vulvar Crohn’s disease preceding intestinal manifestations: a case report and short review

Acta Dermatovenerologica Alpina Pannonica et Adriatica ◽

10.15570/actaapa.2019.32 ◽

2019 ◽

Vol 28 (3) ◽

Author(s):

Georgia Kyriakou ◽

Maria Gkermpesi ◽

Konstantinos Thomopoulos ◽

Markos Marangos ◽

Sophia Georgiou

Keyword(s):

Crohn’S Disease ◽

Case Report ◽

Crohn's Disease ◽

Short Review

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The role of epigenetic modifications for the pathogenesis of Crohn's disease

Clinical Epigenetics ◽

10.1186/s13148-021-01089-3 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

M. Hornschuh ◽

E. Wirthgen ◽

M. Wolfien ◽

K. P. Singh ◽

O. Wolkenhauer ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Adaptive Immune Response ◽

Adaptive Immune ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

New Biomarkers ◽

Insight Into ◽

Specific Evaluation

AbstractEpigenetics has become a promising field for finding new biomarkers and improving diagnosis, prognosis, and drug response in inflammatory bowel disease. The number of people suffering from inflammatory bowel diseases, especially Crohn's disease, has increased remarkably. Crohn's disease is assumed to be the result of a complex interplay between genetic susceptibility, environmental factors, and altered intestinal microbiota, leading to dysregulation of the innate and adaptive immune response. While many genetic variants have been identified to be associated with Crohn's disease, less is known about the influence of epigenetics in the pathogenesis of this disease. In this review, we provide an overview of current epigenetic studies in Crohn's disease. In particular, we enable a deeper insight into applied bioanalytical and computational tools, as well as a comprehensive update toward the cell-specific evaluation of DNA methylation and histone modifications.

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An unusual case of chronic abdominal pain: an association between Celiac disease and Crohn’s disease

Oxford Medical Case Reports ◽

10.1093/omcr/omab008 ◽

2021 ◽

Vol 2021 (4) ◽

Author(s):

Leen Jamel Doya ◽

Maria Naamah ◽

Noura Karkamaz ◽

Narmin Hajo ◽

Fareeda Wasfy Bijow ◽

...

Keyword(s):

Crohn’S Disease ◽

Abdominal Pain ◽

Celiac Disease ◽

Crohn's Disease ◽

Histological Study ◽

Gastrointestinal Diseases ◽

Bowel Diseases ◽

Oral Corticosteroids ◽

History Of ◽

High Caloric Diet

ABSTRACT Inflammatory bowel diseases (IBD) and Celiac disease (CeD) are immune-mediated gastrointestinal diseases with incompletely understood etiology. Both diseases show a multifactorial origin with a complex interplay between genetic, environmental factors, and some components of the commensal microbiota. The coexistence of celiac disease with Crohn’s disease is rarely reported in the literature. Here, we report a case of a 13-year-old Syrian male who presented with a history of abdominal pain, anorexia and pallor. CeD and Crohn’s disease was documented on gastrointestinal endoscopy and histological study. The patient was treated with a gluten-free, low fiber, high caloric diet, and a course of oral corticosteroids with an improvement in growth rate and abdominal pain.

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