Case Report: Infusion-Related Reactions to Intravenous Infliximab and Subcutaneous Ustekinumab in Pediatric Crohn's Disease

Background: Although the biological agent ustekinumab (UST) is reported to be effective for Crohn's disease (CD) in pediatric as well as adult patients, data on the efficacy and safety of UST in pediatric patients with CD are limited. Here, we describe the case of a pediatric patient who showed an allergic reaction to UST after subcutaneous (SC) maintenance injections but not immediately after initial intravenous (IV) injection.Case Presentation: A 9-year-old boy presented to our hospital with diarrhea lasting 2 years and weight loss, leading to the diagnosis of CD. After prednisolone (PSL) was tapered and discontinued, he promptly relapsed. According to our institution's protocol, we introduced the biological agent infliximab (IFX) with premedication. Coughing and vomiting was observed after the second dose of IFX and it was changed to adalimumab (ADA). However, the effect of ADA gradually disappeared after 18 months; therefore, it was discontinued and he was treated using UST. The first IV UST dose was given after administering hydrocortisone (HDC), an antiallergic and antipyretic analgesic, as premedication, and no obvious adverse reaction was observed. After 8 weeks, UST was subcutaneously injected without premedication. The patient then complained of nausea, dizziness, and headache within 15 min of UST administration. Therefore, for the third dose of UST, HDC was administered again as premedication. However, nausea, dizziness, and headache presented 10 min after UST administration, resulting in discontinuation of further UST treatment.Conclusion: Careful distinction between “true” infusion-related reactions (IRRs) and anaphylaxis or allergic reactions is necessary to determine whether biological agents can be continued after the development of “so-called” IRRs. For true IRRs, it may be possible to continue using the biological agent with appropriate premedication; however, in cases of anaphylaxis, the biological agent itself should be changed.

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Evaluation of the efficacy and safety of adalimumab therapy in pediatric patients with Crohn’s disease

Postępy Nauk Medycznych ◽

10.5604/08606196.1190918 ◽

2015 ◽

Vol 28 (11) ◽

pp. 800-805

Author(s):

Dorota Jarzębicka ◽

Joanna Sieczkowska ◽

Grzegorz Oracz ◽

Jarosław Kierkuś

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Pediatric Patients ◽

Efficacy And Safety ◽

Adalimumab Therapy

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Su1918 Efficacy and Safety of Adalimumab in Pediatric Patients With Crohn's Disease Aged 10 Years and Younger: Subanalysis of IMAgINE 1

Gastroenterology ◽

10.1016/s0016-5085(16)32017-0 ◽

2016 ◽

Vol 150 (4) ◽

pp. S588 ◽

Cited By ~ 1

Author(s):

Frank Ruemmele ◽

Marla Dubinsky ◽

Jeffrey S. Hyams ◽

Samantha Eichner ◽

Jen-Fue Maa ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Pediatric Patients ◽

Efficacy And Safety

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Faculty Opinions recommendation of Long-term Efficacy and Safety of Adalimumab in Pediatric Patients with Crohn's Disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727246973.793568135 ◽

2019 ◽

Author(s):

Ashish Patel

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Pediatric Patients ◽

Efficacy And Safety ◽

Term Efficacy

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Tu1944 Efficacy and Safety of Standard vs Low Dose Adalimumab Maintenance Therapy As a Function of Disease Severity in Pediatric Patients With Crohn's Disease: Subanalysis of Imagine 1

Gastroenterology ◽

10.1016/s0016-5085(13)63300-4 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-887 ◽

Cited By ~ 1

Author(s):

Jeffrey S. Hyams ◽

Wallace Crandall ◽

Joel R. Rosh ◽

Frank Ruemmele ◽

Johanna C. Escher ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Maintenance Therapy ◽

Disease Severity ◽

Low Dose ◽

Pediatric Patients ◽

Efficacy And Safety

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Efficacy and safety of certolizumab pegol therapy for 26 weeks in an unselected Crohn's disease population: Results of the FACTS II survey

Zeitschrift für Gastroenterologie ◽

10.1055/s-0030-1263685 ◽

2010 ◽

Vol 48 (08) ◽

Author(s):

SR Vavricka ◽

A Schöpfer ◽

G Bansky ◽

J Binek ◽

C Felley ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Certolizumab Pegol ◽

Efficacy And Safety

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Faculty Opinions recommendation of Long-term Efficacy and Safety of Stem Cell Therapy (Cx601) for Complex Perianal Fistulas in Patients With Crohn's Disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732366531.793553283 ◽

2018 ◽

Author(s):

Eduard Stange

Keyword(s):

Stem Cell ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Cell Therapy ◽

Stem Cell Therapy ◽

Efficacy And Safety ◽

Perianal Fistulas ◽

Term Efficacy

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Efficacy and Safety of Dose Escalation to Adalimumab 80 mg Every Other Week in Japanese Patients with Crohn’s Disease Who Lost Response to Maintenance Therapy

Inflammatory Intestinal Diseases ◽

10.1159/000486786 ◽

2017 ◽

Vol 2 (4) ◽

pp. 228-235 ◽

Cited By ~ 2

Author(s):

Satoshi Motoya ◽

Mamoru Watanabe ◽

Kori Wallace ◽

Andreas Lazar ◽

Yasuko Nishimura ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Maintenance Therapy ◽

Dose Escalation ◽

Japanese Patients ◽

Efficacy And Safety

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Transperineal total mesorectal excision for rectal cancer on the residual rectum after multiple abdominal surgeries in a patient with Crohn’s disease: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01206-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Shin Emoto ◽

Shigenori Homma ◽

Tadashi Yoshida ◽

Nobuki Ichikawa ◽

Yoichi Miyaoka ◽

...

Keyword(s):

Rectal Cancer ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Intraoperative Complications ◽

Rectal Stump ◽

Stage I ◽

Colonoscopic Examination ◽

Case Presentation ◽

History Of ◽

Blood Loss Volume

Abstract Background The improved prognosis of Crohn’s disease may increase the opportunities of surgical treatment for patients with Crohn’s disease and the risk of development of colorectal cancer. We herein describe a patient with Crohn’s disease and a history of multiple surgeries who developed rectal stump carcinoma that was treated laparoscopically and transperineally. Case presentation A 51-year-old man had been diagnosed with Crohn’s disease 35 years earlier and had undergone several operations for treatment of Crohn’s colitis. Colonoscopic examination was performed and revealed rectal cancer at the residual rectum. The patient was then referred to our department. The tumor was diagnosed as clinical T2N0M0, Stage I. We treated the tumor by combination of laparoscopic surgery and concomitant transperineal resection of the rectum. While the intra-abdominal adhesion was dissected laparoscopically, rectal dissection in the correct plane progressed by the transperineal approach. The rectal cancer was resected without involvement of the resection margin. The duration of the operation was 3 h 48 min, the blood loss volume was 50 mL, and no intraoperative complications occurred. The pathological diagnosis of the tumor was type 5 well- and moderately differentiated adenocarcinoma, pT2N0, Stage I. No recurrence was evident 3 months after the operation, and no adjuvant chemotherapy was performed. Conclusion The transperineal approach might be useful in patients with Crohn’s disease who develop rectal cancer after multiple abdominal surgeries.

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