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Severe Acute Respiratory Distress Syndrome during Infliximab Therapy in a Patient with Crohn Disease

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ABSTRACT

The occurrence of a noninfectious interstitial lung disease is a rare but life-threatening side effect of infliximab, an antitumor necrosis factor alpha antibody. The following case report of a patient with Crohn disease shows an extremely dramatic progression to a severe acute respiratory distress syndrome.

No MeSH data available.


Functional respiratory test. The diminished vital capacity (VC) and total lung capacity (TLC) but normal Tiffeneau index (FEV 1% FVC) indicate a restriction. The diminished diffusion capacity for CO (DLCO) of the single breath (33%) shows a severe diffusion disorder.
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Figure 2: Functional respiratory test. The diminished vital capacity (VC) and total lung capacity (TLC) but normal Tiffeneau index (FEV 1% FVC) indicate a restriction. The diminished diffusion capacity for CO (DLCO) of the single breath (33%) shows a severe diffusion disorder.

Mentions: In October 2015, the patient was admitted to our ward with progressive dyspnea. At hospital admission, the leucocytes were 5.61 × 103/µl (normal range 4.0–11.0 × 103/µl), but C-reactive protein was elevated to 49.4 mg/l (reference ≤5.0). Auscultation showed a crackle on both sides. We escalated the antibiotic therapy to moxifloxacin and clarithromycin. The urine and blood bacterial cultures were negative. In the blood serology, there was no evidence of Aspergillus, Candida, Cryptococcus, Chlamydia pneumoniae, Chlamydia psittaci, Legionella, Mycoplasma pneumoniae, Coxiella burneti or Aspergillus. The functional respiratory tests showed a restriction and a severe diffusion disorder (fig 2). The bronchoscopy showed signs of a chronic bronchitis, and there was no evidence of malignity. The follow-up chest X-ray showed reticular signs on both sides (fig 1b). Computed tomography (CT) imaging demonstrated pronounced reticular and fibrotic changes within the lung parenchyma suggestive of idiopathic lung fibrosis (fig 11c).


Severe Acute Respiratory Distress Syndrome during Infliximab Therapy in a Patient with Crohn Disease
Functional respiratory test. The diminished vital capacity (VC) and total lung capacity (TLC) but normal Tiffeneau index (FEV 1% FVC) indicate a restriction. The diminished diffusion capacity for CO (DLCO) of the single breath (33%) shows a severe diffusion disorder.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121573&req=5

Figure 2: Functional respiratory test. The diminished vital capacity (VC) and total lung capacity (TLC) but normal Tiffeneau index (FEV 1% FVC) indicate a restriction. The diminished diffusion capacity for CO (DLCO) of the single breath (33%) shows a severe diffusion disorder.
Mentions: In October 2015, the patient was admitted to our ward with progressive dyspnea. At hospital admission, the leucocytes were 5.61 × 103/µl (normal range 4.0–11.0 × 103/µl), but C-reactive protein was elevated to 49.4 mg/l (reference ≤5.0). Auscultation showed a crackle on both sides. We escalated the antibiotic therapy to moxifloxacin and clarithromycin. The urine and blood bacterial cultures were negative. In the blood serology, there was no evidence of Aspergillus, Candida, Cryptococcus, Chlamydia pneumoniae, Chlamydia psittaci, Legionella, Mycoplasma pneumoniae, Coxiella burneti or Aspergillus. The functional respiratory tests showed a restriction and a severe diffusion disorder (fig 2). The bronchoscopy showed signs of a chronic bronchitis, and there was no evidence of malignity. The follow-up chest X-ray showed reticular signs on both sides (fig 1b). Computed tomography (CT) imaging demonstrated pronounced reticular and fibrotic changes within the lung parenchyma suggestive of idiopathic lung fibrosis (fig 11c).

View Article: PubMed Central - PubMed

ABSTRACT

The occurrence of a noninfectious interstitial lung disease is a rare but life-threatening side effect of infliximab, an antitumor necrosis factor alpha antibody. The following case report of a patient with Crohn disease shows an extremely dramatic progression to a severe acute respiratory distress syndrome.

No MeSH data available.