A Unique Infusion Reaction to Vedolizumab in a Patient With Crohn’s Disease

Abstract

Question: A 53-year-old man with a history of stricturing Crohn's disease, well-controlled on vedolizumab, presented to the emergency room with an acute onset lower extremity rash and joint pain. The patient was diagnosed with Crohn's disease 16 years prior and had tried multiple treatment regimens, including steroids and antibiotics, before initiating vedolizumab. He received his 14th vedolizumab infusion without incident but roughly 5 hours later, noted the development of a pruritic rash on his ankles and the dorsum of his feet. The following morning, the rash had spread cranially, terminating at the buttocks and was associated with diffuse low back, ankle, and knee pain as well as profound malaise and crampy abdominal pain. On presentation to the emergency room, his vital signs were within normal limits. The examination was remarkable for nonblanching purpura covering the lower extremities up to the gluteal folds, more prominent on the left side, as well as pain with active and passive range of motion of both ankles and knees (Figure A, B). Laboratory analysis was only significant for an erythrocyte sedimentation rate of 67 mm/h (which was 6 mm/h 2 days prior) and a creatinine of 1.34 mg/dL (baseline creatinine was 1.1 mg/dL). Platelet count was 290 Â 10 3 /mL, and the white blood cell count was 5.9 Â 10 3 /mL. Urinalysis showed proteinuria without hematuria. Dermatology was called to evaluate the rash and a punch biopsy of the skin was performed. The patient was given 5 days of oral steroids and discharged home. What is the diagnosis? Look on page 982 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and images in GI.

Acute Chest Pain as an Infusion Reaction to Vedolizumab

“…The most common vedolizumab-related adverse effects reported are nasopharyngitis, upper respiratory tract infections, headaches, and arthralgia [ 1 , 2 , 3 ]. Few additional rare adverse events have been described in the literature including dermatologic- and pulmonary-related adverse events [ 4 , 5 , 6 ]. Cases of infusion reactions following vedolizumab administration are uncommon.…”