IMMUNOLOGICAL CHANGES IN NEWBORN EXPOSED TO ANTI-TNF-A, A PERSPECTIVE.

Abstract

<h3>Introduction</h3> Anti-TNF drugs have been used extensively for different autoimmune conditions. There is still an existing debate about the use of anti-tumor necrosis factor monoclonal antibodies during pregnancy vis-à-vis their safety and effects on the fetus developing immune system. <h3>Case Description</h3> A 2 month-old boy was born in the setting of a pregnancy during which the mother was being treated with infliximab for Crohn's disease. Weeks after delivery, mom noted a swollen lymph node appeared on the left side of his neck. As well as lymphadenopathy in both groins which subsequently became infected. He underwent incision and drainage of the cervical and groin lymphadenitis. Patient was placed on Keflex. However, during the course of the treatment, he presented recurrent episodes of lymphadenitis requiring a prolonged therapy with Keflex. Upon his evaluation he was alert and afebrile. A large lymph node of about 3 cm over left side of neck and both groins were noted. The left inguinal lymph node was inflamed, infected and oozing pus. An extensive immunological work up was ordered confirming an elevated Infliximab drug level in the patient's serum. Also, the majority of the cytokines evaluated were within normal range even during the course of an active infection. <h3>Discussion</h3> The decision to use anti-TNF-α during pregnancy with the resulting in-utero exposure to the fetus should be discussed with pregnant patients suffering from autoimmunity. Infliximab does interfere with the IL-12/INF-γ making exposed newborns susceptible to repeated infections by causing a temporary condition analogous to a form of primary immunodeficiency.