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DI-086 Interstitial lung disease induced by infliximab: a case report
  1. H Pluchart1,
  2. S Chanoine1,2,3,
  3. L Beaumier1,
  4. S Quetant4,
  5. C Pison3,4,
  6. P Bedouch1,2,3
  1. 1Centre Hospitalier Universitaire Grenoble Alpes, Pôle Pharmacie, Grenoble, France
  2. 2Université Grenoble Alpes, CNRS TIMC-IMAG UMR 5525, Grenoble, France
  3. 3Université Grenoble Alpes, Faculté de Pharmacie et de Médecine, Grenoble, France
  4. 4Centre Hospitalier Universitaire Grenoble Alpes, Service de Pneumologie, Grenoble, France

Abstract

Background Anti-TNFα drugs are immunosuppressive therapies prescribed in autoimmune diseases. Several clinical cases reported interstitial lung disease (ILD) onset with anti-TNFα drugs.1

Purpose In this clinical case we report ILD onset induced by infliximab in a patient with psoriasis.

Material and methods A literature review and a pharmacovigilance notification were done. The accountability of infliximab in ILD onset was estimated by the Naranjo adverse drug reaction probability scale.

Results The patient was a 57-year-old-man, treated for extensive psoriasis diagnosed in 1970. Our patient received eight medication therapies for psoriasis from 1987 to July 2014. He started therapy with infliximab 5 mg/kg in September 2015, on the following weeks: week 0, week 2, week 6, and then every 8 weeks (no pulmonary contraindication for infliximab for our patient). A significant improvement in skin condition was observed and the last injection of infliximab was in December 2015. In January 2016, our patient had a progressive dyspnoea onset (stage III according to the NYHA classification) 2 weeks after the last infliximab injection, leading to hospitalisation (decrease in vital capacity (VC) from 80% to 50–60%). ILD was shown on imaging, and bronchoalveolar fluid culture and immunological tests were negative. Cytology examinations found lymphocytic alveolitis (40%), supporting the hypothesis of hypersensitivity ILD. Lung function improved 1 month after infliximab cessation, without any medication (antibiotics or corticosteroids). The accountability of infliximab in ILD onset was probable according to Naranjo’s score (score=7/13) In March 2016, VC was 77%, and in May 2016, there was a complete regression of pulmonary infiltration. Today, psoriasis is treated by secukinumab.

Conclusion Our case report suggests a role for infliximab in ILD onset. The link between ILD onset and anti-TNFα drugs remains unclear. Further research has to be conducted to elucidate the role of anti-TNFα agents in ILD onset or in worsening of pre-existing ILD, taking into account patients’ interindividual variability.

References and/or acknowledgements 1. Curtis JR, et al. Incidence and complications of interstitial lung disease in users of tocilizumab, rituximab, abatacept and anti-tumour necrosis factor α agents, a retrospective cohort study. Arthritis Res Ther2015;17(1).

No conflict of interest

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