Febrile Neutropenia with Thrombocytopenia after Infliximab Induction in a Patient with Ulcerative Colitis

Abstract

A 34-year-old female with left-sided ulcerative colitis (UC) developed severe febrile neutropenia/thrombocytopenia soon after infliximab induction therapy. There was no other plausible cause of the cell line abnormalities other than an accurate temporal association with infliximab administration. Supportive care, broad-spectrum antibiotic, and single dose of filgrastim was given on day 5 of admission due to persistently low absolute neutrophil count and fevers. The cell lines recovered, fever resolved and the patient made a complete clinical recovery. Clinicians should be aware of this potential life-threatening inflixmab side effect previously unreported in adults with UC.

Resolved Hypereosinophilic Syndrome and Immune Thrombocytopenic Purpura in Ulcerative Colitis Patients Post Colectomy: A Case Series and Literature Review

“…In this article, we presented two cases of two comorbidities (HES and ITP) occurring in the context of chronic active UC and responding only to surgical colectomy. Though several cases of HES 18,[25][26][27][28] and ITP 14,23,[29][30][31][32][33][34][35][36][37][38][39] have been reported to co-occur with UC, the patients described in this article are unique in their presentation and treatment response. To the best of our knowledge, they represent rare cases of refractory comorbidities in the context of UC that failed conventional medical therapy and responded only to surgical treatment.…”

“…Concomitant occurrence of ITP and UC is rare. 14,23,[29][30][31][32][33][34][35][36][37][38][39] In patients with UC, ITP represents an extraintestinal manifestation of the disease mediated by immune-mediated mechanisms. 29 The differential diagnosis of thrombocytopenia is broad.…”

“…Other cases of ITP were attributed to disease-modifying therapies such as infliximab. 35 Splenectomy was required in a proportion of patients who were refractory to medical therapy. 32,33 Our second patient was a case of refractory ITP that failed steroids, azathioprine, rituximab, romiplostim, anti-TNF therapy, and vedolizumab.…”

“…19 If refractory to steroids, patients can be administered other medications, eg, hydroxyurea, Imatinib (for PDGFRA or PDGFRB variants), or leukopheresis. 19,35 Interferon-α, methotrexate, cyclosporine, cladribine, chlorambucil, vincristine, and etoposide can also be provided in specific cases. 47,48 Our first patient had severe ulcerative pancolitis that failed adalimumab (due to adverse effects) and infliximab.…”