Publication
Infliximab-Induced Lupus: A Case Report
| dc.contributor.author | Pereira, Vítor Magno | |
| dc.contributor.author | Andrade, Carla | |
| dc.contributor.author | Figueira, Ricardo | |
| dc.contributor.author | Faria, Goreti | |
| dc.contributor.author | Jasmins, Luís | |
| dc.date.accessioned | 2019-02-01T10:08:34Z | |
| dc.date.available | 2019-02-01T10:08:34Z | |
| dc.date.issued | 2017-03 | |
| dc.description.abstract | We report the case of a 48-year-old, leukodermic female diagnosed with ulcerative proctitis for 4 years and latent tuberculosis. She was allergic to salicylates and had a minor allergic reaction to infliximab (rash, vertigo, and headache). Thereafter, she started azathioprine (2.5 mg/kg/day). She maintained intravenous infliximab, together with prophylaxis with clemastine and hydrocortisone, due to the steroid-dependent proctitis. The therapy was continued every 8 weeks with anti-tumor necrosis factor for about 3 years. The analytical evaluation when she was diagnosed with ulcerative proctitis (February 2011) showed negative antinuclear antibodies (ANA), double-stranded-DNA antibodies (anti-dsDNA), antineutrophil cytoplasmic antibodies and anti-Saccharomyces cerevisiae antibodies, and a positive outer membrane protein antibody. About 2 years and 6 months after starting infliximab (November 2013), the patient complained of inflammatory symmetrical polyarthralgia (knee, shoulder, elbow, and wrist) without synovitis, which started every week before the administration of infliximab. Resolution of symptoms was observed after each infliximab infusion. In July 2014, the autoantibody re-evaluation showed positive ANA with a homogeneous pattern with a titer of 1:640, weak positive anti-dsDNA (30.2), and positive anti-histone with C3 decreased (80.3). She was then diagnosed with lupus induced by infliximab and initiated hydroxychloroquine 400 mg. Infliximab was suspended. On re-evaluation, the erythrocyte sedimentation rate was 25 mm/h (1st hour), C-reactive protein 0.5 mg/dL (previously erythrocyte sedimentation rate 15 mm/h and C-reactive protein 1.2 mg/dL), and endoscopically, the mucosa was scarred, with some atrophy and scarce mucus in the lower rectum. About 10 months after discontinuation of infliximab, repeated autoantibodies proved all negative, keeping only low C3 (87). The patient also reported complete resolution of the arthralgia. | pt_PT |
| dc.description.abstract | Relato do caso de uma mulher, 48 anos, leucodérmica, com o diagnóstico de proctite ulcerosa com 4 anos de evolução e tuberculose latente. Alérgica aos salicilatos e com reacção alérgica minor ao infliximab (rash, cefaleia e vertigem), iniciou azatioprina (2,5 mg/kg/dia) apenas após a reacção alérgica. Manteve infliximab com profilaxia endovenosa com clemastina e hidrocortisona dada a cortico-depedência da proctite. A terapêutica com antiTNF foi mantida de 8 em 8 semanas durante cerca de 3 anos. Na avaliação analítica aquando o diagnóstico da doença inflamatória intestinal (Fev 2011) apresentava ANA, anti-dsDNA, ANCAs e ASCA negativos com antiOMP positivo. Cerca de 2 anos e meio após o início de infliximab (Nov 2013), iniciou quadro de poliartralgia inflamatória simétrica (joelhos, ombros, cotovelos e punhos) sem sinovite com início regular na semana prévia à admnistração programada de infliximab e resolução após a infusão endovenosa. Em Julho de 2014, apresenta ANA positivos com padrão homogéneo com título de 1/640, anti-dsDNA equívoco (30.2), anti-histonas positivo com C3 diminuído (80.3). Foi diagnosticada com lupus eritematoso sistémico induzido por infliximab e iniciou hidroxicloroquina 400 mg. O infliximab foi suspenso. Na reavaliação da doença, destaca-se VS 25 mm/h (1ª hora), PCR 0,5 mg/dL (previamente VS 15 e PCR 0.6) e endoscopicamente mucosa cicatrizada, com alguma atrofia e escasso muco no recto baixo. Cerca de 10 meses após a suspensão do infliximab, repetiu auto-anticorpos que se revelaram todos negativos, mantendo apenas o C3 baixo (87). Verificou-se ainda resolução completa das queixas articulares. | pt_PT |
| dc.description.version | info:eu-repo/semantics/publishedVersion | pt_PT |
| dc.identifier.citation | Magno Pereira, V., Andrade, C., Figueira, R., Faria, G., & Jasmins, L. (2016). Infliximab-Induced Lupus: A Case Report. GE Portuguese journal of gastroenterology, 24(2), 84-88. | pt_PT |
| dc.identifier.doi | 10.1159/000450877 | pt_PT |
| dc.identifier.uri | http://hdl.handle.net/10400.26/26010 | |
| dc.language.iso | eng | pt_PT |
| dc.publisher | Karger Publishers Open Access | pt_PT |
| dc.subject | Infliximab, therapeutic use | pt_PT |
| dc.subject | Inflammatory bowel diseases, drug therapy | pt_PT |
| dc.subject | Lupus erythematosus, systemic/chemically induced | pt_PT |
| dc.subject | Tumor necrosis factor alpha, therapeutic use | pt_PT |
| dc.subject | Doenças inflamatórias intestinais, tratamento | pt_PT |
| dc.subject | Factor de necrose tumoral alfa, uso terapêutico | pt_PT |
| dc.subject | Infliximab, uso terapêutico | pt_PT |
| dc.subject | Lupus eritematoso, sistémico/induzido quimicamente | pt_PT |
| dc.title | Infliximab-Induced Lupus: A Case Report | pt_PT |
| dc.type | journal article | |
| dspace.entity.type | Publication | |
| oaire.citation.endPage | 88 | pt_PT |
| oaire.citation.issue | 2 | pt_PT |
| oaire.citation.startPage | 84 | pt_PT |
| oaire.citation.volume | 24 | pt_PT |
| person.familyName | Pereira | |
| person.givenName | Vítor | |
| person.identifier.orcid | 0000-0002-9854-086X | |
| rcaap.rights | openAccess | pt_PT |
| rcaap.type | article | pt_PT |
| relation.isAuthorOfPublication | 206b8104-6d62-49eb-ac05-5649bcc1b4b6 | |
| relation.isAuthorOfPublication.latestForDiscovery | 206b8104-6d62-49eb-ac05-5649bcc1b4b6 |