Journal article
A Complex Case of Adalimumab Induced Pleuropericarditis in a Patient with Underlying Ulcerative Colitis
Asploro Journal of Biomedical and Clinical Case Reports, Vol.4(1), pp.16-21
01/02/2021
DOI: 10.36502/2021/ASJBCCR.6223
Abstract
Introduction: Adalimumab is an anti-tumour necrosis factor (anti-TNF) monoclonal antibody and an important part of the treatment regime for autoimmune conditions including inflammatory bowel disease. We present a case of adalimumab induced pleuropericarditis and discuss the diagnosis challenges we faced.
Case History: A 22-year-old male presented to the emergency department with 3 days history of headache, malaise, fever and right-sided chest pain. He was diagnosed with ulcerative colitis 8 months ago but failed to respond to mesalazine, requiring high dose steroids to induce disease remission. His mesalazine was stopped after 4 months and he was initiated on adalimumab 2 months prior to the current presentation. At presentation, he had a temperature of 38.7 °C (101.6 °F) but no other physical signs. His inflammatory markers were raised, and the chest x-ray was clear. He was started on empirical intravenous antibiotics on suspicion of the underlying infective process. On day 4 the patient developed a new pleural rub and crepitations on both lung bases. An urgent echocardiogram and computed tomography scan of the thorax abdomen and pelvis revealed pleural effusion and a 1.8 cm diameter pericardial effusion. Extensive investigation including virology screen, autoimmune screen and pleural fluid analysis were normal.
Diagnosis, Management and Outcome: This case was discussed in a multidisciplinary meeting. A diagnosis of pleuropericarditis secondary to adalimumab was made. Adalimumab and antibiotics were stopped, and he was started on a course of oral steroids. The patient responded well to the treatment and his symptoms resolved.
Conclusion: Rare drug toxicity should be part of differential diagnosis, especially in young patients with unusual presentation. An early multidisciplinary approach is crucial for a positive outcome. The patient should be actively involved in decision making to improve long term outcome.
Details
- Title: Subtitle
- A Complex Case of Adalimumab Induced Pleuropericarditis in a Patient with Underlying Ulcerative Colitis
- Creators
- A AbbasiS Day - Shrewsbury and Telford Hospital NHS TrustM Subahani - University of NottinghamG Townson - West Midlands Police
- Resource Type
- Journal article
- Publication Details
- Asploro Journal of Biomedical and Clinical Case Reports, Vol.4(1), pp.16-21
- DOI
- 10.36502/2021/ASJBCCR.6223
- ISSN
- 2582-0370
- eISSN
- 2582-0370
- Language
- English
- Date published
- 01/02/2021
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984844345502771
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