Diffuse Alveolar Hemorrhage After Infliximab Treatment of Crohnʼs Disease

Panagi, Sofia; Palka, Wojciech; Korelitz, Burton I.; Taskin, Metin; Lessnau, Klaus

doi:10.1097/00054725-200405000-00016

Cited by 38 publications

(15 citation statements)

References 12 publications

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“…Infliximab has been used for therapy of CD for more than a decade now, and a review of 233 cases treated with anti-TNF alpha therapies showed that cutaneous vasculitis was the most common manifestation, and lung involvement primarily occurred in the form of interstitial lung disease (15). There have been several reports of infectious (16)(17)(18) and non-infectious (6,(19)(20)(21) pulmonary complications in patients with CD while on infliximab therapy. Hypersensitivity vasculitis with leukocytoclastic vasculitis (22,23) due to use of infliximab was unlikely because of lack of cutaneous involvement in our patient.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary involvement in CD can sometimes precede the development of intestinal inflammation (4), or occur during the course of treatment -either as an extra-intestinal manifestation of CD (5), because of secondary infections or as a side effect of the therapy itself (6). Granulomatous inflammation within the airways or lung parenchyma can occur due to CD but can also occur because of several other forms of primary and secondary lung disorders (Table 1).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Limited granulomatosis with polyangiitis in an adolescent with Crohn's disease on infliximab therapy: cause or coincidence?

Arora

Madani

Debelenko

et al. 2014

Clinical Respiratory J

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Pulmonary involvement in Crohn's disease (CD) may precede the development of intestinal inflammation, but in most cases occurs during the course of treatment, either as an extra-intestinal manifestation, because of secondary infections, or as a side effect of the therapy itself. This case highlights the differential diagnosis and work up for multiple pulmonary nodules that developed in a patient with CD who had been in remission on infliximab therapy. Even though infectious causes, such as Mycobacteria and Fungi, account for majority of these cases, the possibility of non-infectious conditions such as autoimmune disorders should also be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Limited granulomatosis with polyangiitis in an adolescent with Crohn's disease on infliximab therapy: cause or coincidence?

Arora

Madani

Debelenko

et al. 2014

Clinical Respiratory J

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“…31 However, there are only a few case reports of noninfectious pulmonary complications due to infliximab use numbering less than 15 patients so far in the literature, especially in IBD patients. Acute respiratory distress syndrome, 32 diffuse alveolar hemorrhage, 33 and BOOP, interstitial pneumonitis 34 have been reported in literature. In a paper by Ostor et al 34 recently which is the largest case series of pulmonary toxicity from infliximab, 3 of the 5 patients were on concomitant azathioprine and 2 were on leflunomide which has also been associated with pulmonary toxicity.…”

Section: Discussionmentioning

confidence: 99%

Severe Pulmonary Toxicity After Azathioprine/6-Mercaptopurine Initiation for the Treatment of Inflammatory Bowel Disease

Ananthakrishnan¹,

Attila²,

Otterson³

et al. 2007

Journal of Clinical Gastroenterology

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Azathioprine and 6-mercaptopurine (6-MP) are effective in inflammatory bowel disease (IBD). However, between 10% and 29% of patients treated with these drugs are forced to stop therapy due to side effects. Pulmonary toxicity due to azathioprine/6-MP has been reported infrequently. We describe 3 patients who developed severe, noninfectious pulmonary toxicity within 1 month after the initiation of azathioprine or 6-MP for the treatment of IBD colitis (2 Crohn's disease and 1 ulcerative colitis). All patients presented with dyspnea, cough, and fever after initiation of azathioprine/6-MP. Evaluation for infectious etiologies, including bronchoscopy (3/3 patients) and open-lung biopsy (2/3 patients) was negative. Histopathologic examination of the lung biopsies revealed bronchiolitis obliterans organizing pneumonia in one, and usual interstitial pneumonitis in another patient. Cessation of purine analog therapy resulted in clinical improvement in all 3 cases. Azathioprine/6-MP-related pulmonary toxicity is a rare but serious side effect, and it is important for clinicians to have a high index of suspicion for this adverse reaction which occurs within 1 month after initiation of treatment for IBD.

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“…However, DAH with associated capillaritis has been reported following the administration of propylthiouracil [61,62], hydralazine [63] and All-trans-retinoic acid (ATRA) [64]. Other drugs including, gemtuzumab ozogamicin [65] and infliximab [66], have reportedly led to DAH although the mechanisms remain unknown.…”

Section: Drug-induced Capillaritismentioning

confidence: 99%

Diffuse Alveolar Hemorrhage

Olson¹,

Schwarz²

2007

Diffuse Parenchymal Lung Disease

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Diffuse alveolar hemorrhage (DAH) refers to a clinical syndrome resulting from injury to the alveolar capillaries, arterioles, and venules leading to red blood cell accumulation in the distal air spaces. It is defined by the clinical triad of hemoptysis, anemia, and progressive hypoxemia. Chest radiographs reveal non-specific patchy or diffuse, bilateral pulmonary infiltrates.The diagnosis requires confirmation of the alveolar hemorrhage by bronchoscopy in which serial bronchoalveolar lavage samples reveal persistently hemorrhagic fluid. A number of conditions are associated with DAH, and underlying disease determines the prognosis and the treatment regimen. While there is no uniformly accepted classification of DAH, it is generally categorized according to the underlying histology. EtiologyA number of conditions have been associated with the clinical syndrome of DAH (table 1). In one study of biopsyconfirmed DAH, Wegener's granulomatosis (WG) was the most frequent underlying condition, followed by Goodpasture's syndrome, idiopathic pulmonary hemosiderosis, and collagen vascular diseases. Overall, vasculitis (either WG or microscopic polyangiitis [MAP]) was the most frequent, representing 41% of cases [1].

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Diffuse Alveolar Hemorrhage After Infliximab Treatment of Crohnʼs Disease

Cited by 38 publications

References 12 publications

Limited granulomatosis with polyangiitis in an adolescent with Crohn's disease on infliximab therapy: cause or coincidence?

Limited granulomatosis with polyangiitis in an adolescent with Crohn's disease on infliximab therapy: cause or coincidence?

Severe Pulmonary Toxicity After Azathioprine/6-Mercaptopurine Initiation for the Treatment of Inflammatory Bowel Disease

Diffuse Alveolar Hemorrhage

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