Heart failure as an adverse effect of infliximab for Crohn's disease: A case report and review of the literature

Abstract

BACKGROUND Anti-tumor necrosis factor agents were the first biologic therapy approved for the management of Crohn's disease (CD). Heart failure (HF) is a rare but potential adverse effect of these medications. The objective of this report is to describe a patient with CD who developed HF after the use of infliximab. CASE SUMMARY A 50-year-old woman with a history of hypertension and diabetes presented with abdominal pain, diarrhea, and weight loss. Colonoscopy and enterotomography showed ulcerations, areas of stenosis and dilation in the terminal ileum, and thickening of the intestinal wall. The patient underwent ileocolectomy and the surgical specimen confirmed the diagnosis of stenosing CD. The patient started infliximab and azathioprine treatment to prevent post-surgical recurrence. At 6 mo after initiating infliximab therapy, the patient complained of dyspnea, orthopnea, and paroxysmal nocturnal dyspnea that gradually worsened. Echocardiography revealed biventricular dysfunction, moderate cardiac insufficiency, an ejection fraction of 36%, and moderate pericardial effusion, consistent with HF. The cardiac disease was considered an infliximab adverse effect and the drug was discontinued. The patient received treatment with diuretics for HF and showed improvement of symptoms and cardiac function. Currently, the patient is using anti-interleukin for CD and is asymptomatic. CONCLUSION This reported case supports the need to investigate risk factors for HF in inflammatory bowel disease patients and to consider the risk-benefit of introducing infliximab therapy in such patients presenting with HF risk factors.

Evaluation of adalimumab effects on left ventricle performance by echocardiography indexes among patients with immunosuppressant refractory ulcerative colitis

“…Based on inclusion and exclusion criteria, the sample size was refined to a slightly smaller size so that a similar study with more prominent participants is recommended for a firm decision regarding anti-TNF utilization. More studies exhibit priming of the cardiac complications in a short period after anti-TNF (12,13), which was the basis of the current perusal sketch; hence, a resemble inquiry with a long-term follow-up is suggested.…”

E-Health Based Heart Failure Intervention: Systematic Literature Review

“…The classification of heart failure severity refers to the NYHA classification, respondents in the study showed the level of NYHA III and IV, which means limited activity with light to reduce the elasticity of the heart arteries, causing damage to the heart [31]. The patient received treatment with diuretics is dominated for HF and showed improvement of symptoms and cardiac function [32].…”

Biologic and Small-Molecule Therapies for Moderate-to-Severe Psoriasis: Focus on Psoriasis Comorbidities

“…Furthermore, a case of sudden death after receiving a single infusion of infliximab 200 mg in a patient without CHF was reported [157]. Another case report described a patient with CD who developed CHF after infliximab treatment [158]. Recently, a case report presents a patient with relapsing hidradenitis suppurativa who was diagnosed with decompensated CHF after receiving adalimumab during hospitalization [159].…”