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

Objectives: Biological medications have been used with an increasing frequency to treat rheumatological diseases. Autoimmune events can be induced by these drugs, such as psoriasiform lesions, alopecia, lupus and, vasculitis, which more often affects the skin (small-sized vessels) and eventually other organs. In this review, we describe the clinical profile of patients with vasculitis induced by the main biological agents used in rheumatology. Patients and methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The PubMed database was used for searching eligible articles. We included case reports, case series, and letter to the editor of patients on anti-tumor necrosis factor-alpha (anti-TNF-a) molecules, as well as tocilizumab, ustekinumab, secukinumab, rituximab, and abatacept, who had vasculitis induced by these agents. Results: Eighty-one articles were included for final analysis (n=89). Twenty-seven patients were using infliximab, 20 adalimumab, 18 etanercept, seven secukinumab, four certolizumab, four rituximab, three golimumab, three ustekinumab, two abatacept, and one tocilizumab. Unspecific leukocytoclastic vasculitis (LCV) was the most common type of vasculitis (n=37), followed by anti-neutrophil cytoplasmic antibody (ANCA)- associated vasculitis (n=16). The medication was replaced with another biological molecule in 23 cases, with only four relapses. In six cases, the biological was maintained, but vasculitis worsened/persisted in one case, being necessary drug removal. Conclusion: Infections, infusion reaction, cancer, and autoimmune events are well-known side effects of biological therapy. This review demonstrates that vasculitis is another adverse effect of this type of therapy, particularly the anti-TNF-a molecules, and LCV the most reported type of vasculitis.

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“…A total of 63.8% of the patients were women with a median age of 48 (range, 16 to 82) years. [ 7 - 72 ]…”

Section: Resultsmentioning

confidence: 99%

Vasculitis induced by biological agents used in rheumatology practice: A systematic review

Duran¹,

Paz²,

Santiago³

2021

Arch Rheumatol

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“…[19][20][21][22][23][24][25] Identification of noncaseating granulomas would have been helpful though those were not present on the tissue sample.…”

Section: Dr Kellermayermentioning

confidence: 99%

A Case of an 11-year-old With Cough, Diarrhea, and Findings of Concern in His Lungs and Spleen

Darby¹,

Rees²,

Bocchini³

et al. 2016

Pediatrics

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This is the case of a previously healthy, 11-year-old male of Indian descent who presented to the emergency department with a 2-month history of nausea, vomiting, diarrhea, fatigue, cough, and 7-lb weight loss. Acutely, he developed 5 days of fever as high as 39.4°C. He had a remote travel history to the Middle East. On physical examination, he was febrile and tachycardic, was thin but otherwise had a normal examination. His inflammatory markers were elevated: erythrocyte sedimentation rate was 93 mm/hour and his C-reactive protein was 25.4 mg/L. A complete blood count revealed a white blood cell count of 17 000 × 10 3 /μL with increased bands. His hemoglobin level was 8.8 g/dL with a mean corpuscular volume of 81 fl. Platelets were 556 × 10 3 /μL. A chest radiograph was concerning for a cavitary lung lesion and an abdominal ultrasound revealed multiple hypoechoic lesions in his spleen. Our panel of experts reviews his case and examines the workup of this patient with diverse symptoms and focal findings on chest radiograph and abdominal ultrasound. abstract Departments of a Pediatrics and b Pathology, Baylor College of Medicine/Texas Children's Hospital, Houston, TexasDr Darby contributed to the design and execution of the case conference, drafted and edited the original manuscript, and made revisions to the manuscript; Drs Rees, Barlow, Kellermayer, Bocchini, Cruz, and Finegold contributed to the design and execution of the case conference and reviewed and made revisions to the manuscript; and all authors approved the fi nal manuscript as submitted.

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Infliximab

2015

Reactions Weekly

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

Cited by 4 publications

References 28 publications

Vasculitis induced by biological agents used in rheumatology practice: A systematic review

Vasculitis induced by biological agents used in rheumatology practice: A systematic review

A Case of an 11-year-old With Cough, Diarrhea, and Findings of Concern in His Lungs and Spleen

Infliximab

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