Treatment of Pulmonary Crohnʼs Disease with Infliximab

Abstract

Purpose: Three teenage patients, previously diagnosed with gastrointestinal Crohn's disease developed severe pulmonary symptoms requiring hospitalization. The Purpose of this investigation is to describe the clinical outcome of their pulmonary disease following treatment with Infliximab. Methods: All three patients had their gastrointestinal symptoms well controlled on combinations of medical therapy that included 6-mercaptopurine, mesalamine, and/or steroids. All 3 patients had chest x-rays that showed diffuse pulmonary infiltrates. One patient had a left-sided pleural effusion. Results: CT scans confirmed the radiographic findings. Open lung biopsies in 2 patients showed non-necrotic, non-caseating granulomas consistent with pulmonary Crohn's disease. The other patient had evidence of organizing pneumonia. The 2 patients with pulmonary granulomas were treated initially with infliximab (5 mg/kg) that resulted in rapid improvement of respiratory symptoms within 3 days. The patient with organizing pneumonia was treated with high-dose steroids and intravenous broad spectrum antibiotics and after 2 weeks showed no significant improvement. He was subsequently treated with infliximab (5 mg/kg) that resulted in an equally rapid improvement of his respiratory symptoms. All patients were discharged from the hospital within 3 days of these infusions and all received repeat infliximab infusions at 2 and 6 weeks following the initial infusion and every 8 weeks thereafter. At the present time the follow-up, which ranges from 1 to 18 months, has shown all 3 patients to be free of all respiratory symptoms. Conclusions: Pulmonary involvement, rarely reported in the pediatric population, has been identified in patients with Crohn's disease. Infliximab therapy, which is well-tolerated, may be the drug of choice for these patients.