Carcinoma in the residual rectum of a long‑standing Crohn's disease patient following subtotal colectomy: A case report

Abstract: Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication, occurring to patients undergoing treatment with antiresorptive medication, such as bisphosphonates, denosumab or bevacizumab, for different oncologic and non-oncologic diseases. The aim of this study is to report a case of MRONJ in a young patient treated with infliximab, a tumor necrosis factor-a inhibitor used in the treatment of immune-mediated inflammatory diseases such Crohn’s disease, ulcerative colitis, ankylosing spondylitis, rheumatoid and psoriatic arthritis. Case Report: A 27-year-old female patient diagnosed with Crohn’s disease, who had been undergoing intravenous infliximab therapy every seven weeks for 8 years, sought our oral and plastic maxillofacial department with a peri-mandibular abscess for further treatment. The patient underwent surgical treatment, including the extraoral sub-mandibular incision of the abscess and the extraction of the lower second premolar under the administration of intravenous antibiotics. We traced a wound dehiscence and delayed healing procedure of the extraction’s alveolar bone, and five weeks later, the patient returned with an abscess recurrence around the mandibular angle area. The patient underwent surgical treatment with wide bone resection and debridement of the necrotic tissues. After follow-up (4 months), the patient completely healed without signs of recurrence. Discussion: Osteomyelitis of the jaw by patients treated with infliximab has been sparsely described in publications. This case confirms the potential role of infliximab in the pathogenesis of MRONJ. Since the pathomechanism of MRONJ under infliximab therapy remains unclear, we recommend a regular oral check-up before starting therapy, as well as during the therapy with infliximab, in order to possibly prevent the MRONJ onset. Keywords: Medication-Related Osteonecrosis of the Jaw, Infliximab, TNF-a Inhibitors, Crohn’s Disease and Osteomyelitis.

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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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