Infliximab treatment in a hemodialysis patient with relapse of Crohn's disease after a 40-year interval

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  • ４０年を経過した後に再発したクローン病に対してｉｎｆｌｉｘｉｍａｂの使用を試みた維持透析患者の１例
  • 症例報告 40年を経過した後に再発したクローン病に対してinfliximabの使用を試みた維持透析患者の1例
  • ショウレイ ホウコク 40ネン オ ケイカ シタ アト ニ サイハツ シタ クローンビョウ ニ タイシテ infliximab ノ シヨウ オ ココロミタ イジ トウセキ カンジャ ノ 1レイ

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Abstract

As Crohn's disease (CD) is sometimes difficult to treat with standard medication alone, alternative therapies are needed. We describe a 69-year-old man with CD complicated by chronic renal failure successfully treated with infliximab after mesalazine and prednisolone treatment failed. However, there has been limited experience with CD patients undergoing hemodialysis while being treated with TNF-α inhibitors. Although he was complicated by pneumocystis jivorecii pneumonia (PCP) during the course of the second infusion of infliximab, we successfully managed the physical symptoms and fiberscopic findings using two intravenous doses of infliximab. A 69-year-old patient with chronic renal failure started hemodialysis in September 2005. He had a past history of CD 40 years earlier. He was admitted to our hospital to establish control of hypertention in July 2008. Four days after his wife's sudden death, he complained of the abrupt onset of melena and diarrhea. He was initially treated with mesalazine and nutrition treatment. About one month later, he relapsed again. Then prednisolone per 30mg/day was started. Twenty days later, he required 1,600mL blood transfusion in total due to frequent melena. Since he had already undergone excision of segments of the large intestine several times in the past, we selected treatment with intravenous infusion of infliximab. He was complicated by PCP two weeks after the second infusion of infliximab, but was successfully treated with both ST drugs and 1,000mg of pulse methyl-prednisolone treatment. After 6 months, there have not been any clinical or laboratory side effects and he remains in clinical remission. Tumor necrosis factor-α (TNF-α) is pivotal cytokine in the pathogenesis of CD that emerged as a promising therapeutic target based on experimental studies employing specific biological inhibitors. Infliximab is a chimeric mouse/human anti-TNF-α monoclonal antibody that has been shown to be effective for CD. This case study suggests that infliximab treatment might be well tolerated and effective therapy for CD patients undergoing hemodialysis despite the special attention required for complicated infection.

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