Infliximab is effective in the treatment of ulcerative colitis with dermatomyositis: A case report

Abstract

BACKGROUND Joint, skin, oral cavity, and eye lesions are the most common extraintestinal manifestations of ulcerative colitis that can occur before or after its onset. The cases of ulcerative colitis with dermatomyositis (DM) are rare. In this study, we report a rare case of ulcerative colitis with DM that was effectively treated with infliximab. CASE SUMMARY The patient was a 57-year-old female with a 2-year history of DM. The patient was admitted to hospital with abdominal pain, diarrhea, and blood in stool lasting for more than 2 mo. Colonoscopy revealed multiple erosions and ulcers in the entire colon and rectum. Pathological sections showed chronic inflammatory cell infiltration, especially neutrophil infiltration, in the colonic mucosa; therefore, the patient was diagnosed with ulcerative colitis. Preparations of 5-aminosalicylic acid was added to her treatment based on the original treatment for DM, but its effect was unsatisfactory. The patient’s discomfort was relieved after infliximab treatment. CONCLUSION Infliximab can improve DM in the treatment of ulcerative colitis. Specialists need to raise awareness about patients with inflammatory bowel disease who have rare extraintestinal manifestations.

Advancements in the Treatment of Cutaneous Lupus Erythematosus and Dermatomyositis: A Review of the Literature

“… Skin and joint symptoms improved completely after 1.5 months of treatment. Huang (2020) 56 Case report Infliximab 5 mg/kg at weeks 0, 2 and 6, then q8weeks thereafter for an unspecified duration 57-year-old female with DM with eyelid edema, limb weakness, and swallowing difficulties Patient had clinical improvement in rash, muscle pain, and weakness on all subsequent follow up visits. Chen (2013) 57 Retrospective review Infliximab 5 mg/kg at weeks 0, 2 and 6, then q8weeks thereafter 14 females with average age 52.57 years old with DM.…”

“…51 Biologic therapies targeting the TNF-alpha pathway -infliximab, adalimumab, and etanercept -generally showed reductions in DM activity by either CDASI or DAS score, but statistical significance was not achieved in an RCT studying etanercept. [54][55][56][57][58][59][60][61][62][63][64][65][66] Applications of other biologics such as ustekinumab and IMO-8400 have shown some limited success in single patients, although the former is limited to one case report and the latter was found to result in no significant difference by an RCT. 67,68 The cannabinoid agonist, lenabasum, was found to significantly decrease patient mean CDASI.…”

“…Huang (2020) 56 Case report Infliximab 5 mg/kg at weeks 0, 2 and 6, then q8weeks thereafter for an unspecified duration 57-year-old female with DM with eyelid edema, limb weakness, and swallowing difficulties Patient had clinical improvement in rash, muscle pain, and weakness on all subsequent follow up visits.…”

“…Infliximab, a chimeric IgG1κ mAb binding TNF-α, at 3 or 5 mg/kg greatly reduced or completely resolved DMassociated skin rashes in most patients. [54][55][56][57][58][59][60][61] One retrospective review of 14 female patients with an average age of 52.6 years old found that 10 out of 14 patients experienced a favorable treatment response with both improved skin findings and motor function. 57 A similar study in a pediatric cohort of 39 children found a significant modified skin DAS decrease from a group median of 4/5 to a 2/5 after 6 months (p = 0.002) and to 1/5 after 12 months (p = 0.0006) of treatment.…”

Disseminated tuberculosis following negative QuantiFERON-TB gold tests during infliximab therapy: Implications for screening of hidradenitis suppurativa

“…TNFIs are the standard of care in the management of HS. However, this treatment represents an increased risk of reactivation of TB, with most cases 4 documented in the rheumatologic 5 , 6 and gastroenterological 6 , 7 literature. Specifically, there is a fourfold risk of mycobacterium infection with TNFIs.…”