A RARE AND UNDER RECOGNIZED CAUSE OF PNEUMONITIS

Abstract

TYPE: Case Report 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