Song Y, Shi YH, He C, Liu CQ, Wang JS, Zhao YJ, Guo YM, Wu RJ, Feng XY, Liu ZJ. Severe Henoch-Schönlein purpura with infliximab for ulcerative colitis. World J Gastroenterol 2015; 21(19): 6082-6087 [PMID: 26019477 DOI: 10.3748/wjg.v21.i19.6082]
Corresponding Author of This Article
Zhan-Ju Liu, MD, PhD, Professor, Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University, No. 301 Yanchang Road, Zhabei District, Shanghai 200072, China. liuzhanju88@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. May 21, 2015; 21(19): 6082-6087 Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.6082
Severe Henoch-Schönlein purpura with infliximab for ulcerative colitis
Yang Song, Yan-Hong Shi, Chong He, Chang-Qin Liu, Jun-Shan Wang, Yu-Jie Zhao, Yan-Min Guo, Rui-Jin Wu, Xiao-Yue Feng, Zhan-Ju Liu
Yang Song, Yan-Hong Shi, Chong He, Chang-Qin Liu, Jun-Shan Wang, Yu-Jie Zhao, Yan-Min Guo, Rui-Jin Wu, Xiao-Yue Feng, Zhan-Ju Liu, Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China
Author contributions: Song Y and Shi YH contributed equally to this study; Liu ZJ and Liu CQ designed the study; Wang JS, Wu RJ and Zhao YJ collected the patients' clinical data; He C, Guo YM and Feng XY performed the experiments; Song Y and Shi YH analyzed the data and wrote the manuscript.
Supported by National Natural Science Foundation of China, No. 81270470.
Ethics approval: The study was reviewed and approved by the Hospital and University Review Committees for Medical Research.
Informed consent: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors declared no conflict interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zhan-Ju Liu, MD, PhD, Professor, Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University, No. 301 Yanchang Road, Zhabei District, Shanghai 200072, China. liuzhanju88@126.com
Telephone: +86-21-66301164 Fax: +86-21-66303983
Received: November 23, 2014 Peer-review started: November 24, 2014 First decision: December 11, 2014 Revised: January 16, 2015 Accepted: February 11, 2015 Article in press: February 11, 2015 Published online: May 21, 2015 Processing time: 177 Days and 18.2 Hours
Abstract
Infliximab (IFX) is an anti-tumor necrosis factor chimeric antibody that is effective for treatment of autoimmune disorders such as Crohn’s disease and ulcerative colitis (UC). IFX is well tolerated with a low incidence of adverse effects such as infections, skin reactions, autoimmunity, and malignancy. Dermatological manifestations can appear as infusion reaction, vasculitis, cutaneous infections, psoriasis, eczema, and skin cancer. Here, we present an unusual case of extensive and sporadic subcutaneous ecchymosis in a 69-year-old woman with severe UC, partial colectomy and cecostomy, following her initial dose of IFX. The reaction occurred during infliximab infusion, and withdrawal of IFX led to gradual alleviation of her symptoms. We concluded that Henoch-Schönlein purpura, a kind of leukocytoclastic vasculitis, might have contributed to the development of the bruising. Although the precise mechanisms of the vasculitis are still controversial, such a case highlights the importance of subcutaneous adverse effects in the management of UC with IFX.
Core tip: Infliximab (IFX) is effective in the management of ulcerative colitis (UC). Henoch-Schönlein purpura (HSP) appears as a dermatological adverse effect of IFX. However, extensive ecchymosis in old UC patients is rare. This report describes a case of HSP reaction, which resolved upon IFX withdrawal.
