Journal Article

Complications of Tumor Necrosis Factor-± Blockade in Chronic Granulomatous Disease—Related Colitis

Gulbu Uzel, Jordan S. Orange, Nina Poliak, Beatriz E. Marciano, Theo Heller and Steven M. Holland

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 51, issue 12, pages 1429-1434
Published in print December 2010 | ISSN: 1058-4838
Published online December 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/657308
Complications of Tumor Necrosis Factor-± Blockade in Chronic Granulomatous Disease—Related Colitis

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Background. Chronic granulomatous disease (CGD) is a genetic disorder of the phagocyte NADPH oxidase, which predisposes patients to infections and inflammatory complications, including severe colitis. Management of CGD colitis is a challenge because standard immunosuppressive therapy increases the risk of infection in already immunocompromised hosts.

Methods. We report the use of infliximab in 5 patients with CGD.

Results. Infliximab administration predisposed patients to severe infections with typical CGD pathogens but not mycobacteria, as reported with infliximab in other conditions. In addition to infections, infliximab administration led to successful closure of fistulae, sometimes with other untoward consequences. Infliximab-associated complications were associated with 2 deaths.

Conclusions. Infliximab use in the treatment of CGD inflammatory bowel disease requires aggressive antimicrobial prophylaxis, assiduous surveillance for infection, and vigilance for untoward gastrointestinal complications. This experience suggests that infliximab therapy is effective but has untoward consequences in patients with CGD.

Journal Article.  3579 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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