The safety of vedolizumab in a patient with Crohn's disease who developed anti-TNF-alpha agent associated latent tuberculosis infection reactivation: A case report.

Abstract

RATIONALE:

Latent tuberculosis (TB) infection screening before inducing anti-tumor necrosis factor (anti-TNF) alpha agents is important to prevent TB reactivation. However, latent TB infection reactivation may still occur, and the ideal therapeutic strategy for patients with inflammatory bowel disease (IBD) who develop active TB infection has not been established. Vedolizumab (VDZ) has a good safety profile, with low incidence rates of serious infections. However, its safety in patients with latent TB infection reactivation associated with anti-TNF-alpha agents remains unknown.

PATIENT CONCERNS:

A 21-year-old Vietnamese male patient presented to our hospital with hemorrhagic stool. He had no personal or family history of IBD or TB.

DIAGNOSES:

Colonoscopy revealed multiple longitudinal ulcers and a cobblestone appearance in the terminal ileum, as well as multiple small erosions and aphtha throughout the colon. Computed tomography revealed a right lung nodular lesion. Serological interferon-gamma release assay and several culture tests were all negative. Thus, he was diagnosed with ileocolonic Crohn's disease (CD) without TB.

INTERVENTIONS:

The intravenous anti-TNF-alpha agent administration with an immunomodulator was initiated.

OUTCOMES:

Computed tomography revealed nodular lesion expansion at the right lung, and serological interferon-gamma release assay was positive. He was diagnosed with latent TB infection reactivation. Anti-TNF-alpha agent with an immunomodulator was immediately discontinued, and anti-TB therapy was initiated. His endoscopic findings were still active, and VDZ was selected for maintenance therapy because VDZ has a favorable safety profile with low incidence rates of serious infections. Consequently, mucosal healing was achieved without active TB relapse.

LESSONS:

This case report presented a patient in whom VDZ was continued as maintenance therapy without inducing TB relapse in a patient with CD who developed latent TB infection reactivation associated with anti-TNF-alpha agents and summarized the safety profile of VDZ for patients with IBD with active or latent TB infection. VDZ may be a safe option for induction and maintenance therapy in patients with CD, even in cases with latent TB infection reactivation.

• Authors: Yuya Sugiyama, Nobuhiro Ueno, Shion Tachibana, Yu Kobayashi, Yuki Murakami, Takahiro Sasaki, Aki Sakatani, Keitaro Takahashi, Katsuyoshi Ando, Shin Kashima, Kentaro Moriichi, Hiroki Tanabe, Toshikatsu Okumura, Mikihiro Fujiya
• Journal: Medicine (Medicine (Baltimore)) Vol. 102 Issue 28 Pg. e34331 (Jul 14 2023) ISSN: 1536-5964 [Electronic] United States
• PMID: 37443475 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• vedolizumab
• Tumor Necrosis Factor Inhibitors
• Gastrointestinal Agents
• Tumor Necrosis Factor-alpha

Topics

• Humans
• Male
• Young Adult
• Adult
• Crohn Disease (drug therapy)
• Latent Tuberculosis (diagnosis, drug therapy)
• Tumor Necrosis Factor Inhibitors (therapeutic use)
• Gastrointestinal Agents (adverse effects)
• Retrospective Studies
• Inflammatory Bowel Diseases (complications, drug therapy)
• Tumor Necrosis Factor-alpha (therapeutic use)
• Tuberculosis (drug therapy)