Case report: Eosinophilic pneumonia associated with vedolizumab therapy in a patient with ulcerative colitis

Abstract

Extraintestinal manifestations are common in patients with inflammatory bowel disease, while respiratory involvement is less common. Vedolizumab is a new class of anti-integrin biological agents approved for treating inflammatory bowel disease. In this report, we present the case of a 38-year-old patient with ulcerative colitis for 7 years who developed cough, fever, and pulmonary infiltrates after taking vedolizumab. There was a spontaneous improvement in clinical symptoms and radiological abnormalities after discontinuing vedolizumab and introducing steroids. Despite the rarity of vedolizumab-induced eosinophilic pneumonia, the case reports indicate that patients with unexplained respiratory symptoms that are taking vedolizumab should be fully contemplated.

Lung Involvement in Inflammatory Bowel Diseases: Shared Pathways and Unwanted Connections

“…Cases of granulomatous lung disease [160,161] and necrobiotic pulmonary nodules in patients with Crohn's disease during treatment with vedolizumab have been described [162]. Rare cases of eosinophilic pneumonia and eosinophilic bronchial asthma in patients with UC under vedolizumab therapy have also been described [163,164].…”

Late onset vedolizumab-induced eosinophilic pneumonia in a patient with ulcerative colitis

“…Possible mechanisms underlying pulmonary eosinophilic toxicity and anti-integrins are not completely understood. Speculative hypotheses include anti-integrin-associated blockage of cellular ingress into the gastrointestinal tract, allowing for the dissemination of immune effector cells to extraintestinal sites; overexpression of alternative integrins like α4β1, resulting in altered patterns of cellular localization/migration to intestinal and extraintestinal sites; and an idiosyncratic reaction to the drug [4,5]. Lissner et al .…”