A rare and under recognized cause of pneumonitis
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Authors
Joshi, V
Mouyis, M
Ather, A
Fishman, D
Issue Date
2022
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Published Abstract
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Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Lung diseases
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Abstract
TOPIC: Diffuse Lung Disease
INTRODUCTION: Anti-TNF inhibitors are increasingly known to cause both infective (re-activation of TB, opportunistic or atypical infections) and inflammatory pulmonary complications. The exact mechanism for inflammatory complications is still unclear.
CASE PRESENTATION: A 52-year-old female, ex-smoker with background history of Crohn’s disease and arthropathy presented with type 1 respiratory failure and markedly raised inflammatory markers (CRP 339mg/L and Ferritin 13,189mcg/L). She had been on long-term Methotrexate and Prednisolone 20mg. She became unwell after she had her third infliximab maintenance infusion. A CT pulmonary angiogram (high D-Dimer - 1961), showed a segmental pulmonary embolus along with diffuse ground glass reticulation with subpleural sparing in the lower lobes (NSIP pattern-fig 1). She was positive for RF, Anti-CCP and HLA-B27 but had negative ANA/ENA profile. She was suspected to have infliximab induced pneumonitis and infliximab was stopped. She was treated with high dose oral Prednisolone 60mg/day with gradual taper over a period of 3 months. The lung function showed normal spirometry with reduced gas transfer. Her interval CT scan in 3 months whilst on oral prednisolone of 5mg/day showed resolution of pneumonitis along-with simultaneous clinical improvement.
DISCUSSION: In this case, temporal relation to the introduction of Infliximab and excellent response to the steroids and cessation of the offending agent point towards this rare diagnosis of Anti-TNF induced pneumonitis.
CONCLUSIONS: Anti-TNF induced acute lung injury is an under recognised cause of pneumonitis and should be suspected, after excluding other causes as clinico-radiological features are non-specific. Patients should be reminded about potential pneumotoxicity when starting infliximab therapy. Fig -1
DISCLOSURE: Nothing to declare.
KEYWORD: INFLIXIMAB
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DIFFUSE LUNG DISEASE| VOLUME 161, ISSUE 6, SUPPLEMENT , A258, JUNE 2022 PDF [81 KB] Save Share Reprints Request A RARE AND UNDER RECOGNIZED CAUSE OF PNEUMONITIS V. JOSHI M. MOUYIS A. ATHER D. FISHMAN DOI:https://doi.org/10.1016/j.chest.2021.12.289
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https://journal.chestnet.org/article/S0012-3692(21)04735-8/fulltext
https://doi.org/10.1016/j.chest.2021.12.289
https://doi.org/10.1016/j.chest.2021.12.289