Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2022; 10(5): 1716-1722
Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1716
Vedolizumab-associated diffuse interstitial lung disease in patients with ulcerative colitis: A case report
Jie Zhang, Mei-Hong Liu, Xue Gao, Chang Dong, Yan-Xia Li
Jie Zhang, Mei-Hong Liu, Chang Dong, Yan-Xia Li, Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Xue Gao, Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Author contributions: Dong C and Zhang J reviewed the literature and contributed to manuscript drafting; Liu MH performed the collection and interpretation of the clinical data and material; Gao X analyzed and interpreted the pathological findings; Li YX was responsible for the revision of the manuscript for important intellectual content; all authors contributed to the manuscript and approved the final version to be submitted.
Supported by the Dalian Municipal Science and Technology Innovation Foundation, No. 2020JJ27SN072.
Informed consent statement: Informed written consent was obtained from the patient’s proxy for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work nonnon-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang Dong, MD, Associate Chief Physician, Associate Professor, Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Xigang District, Dalian 116011, Liaoning Province, China. dongchang8793@163.com
Received: October 11, 2021
Peer-review started: October 11, 2021
First decision: November 7, 2021
Revised: December 18, 2021
Accepted: January 5, 2022
Article in press: January 5, 2022
Published online: February 16, 2022
Processing time: 122 Days and 17.8 Hours
Abstract
BACKGROUND

Vedolizumab, a newer class of integrin antagonist biological agents, has been applied to treat patients with moderate-to-severe Crohn’s disease (CD) and ulcerative colitis (UC), especially for patients who are refractory to traditional therapies and tumor necrosis factor antagonists. However, some rare but life-threatening adverse effects warrant pharmacovigilance. We describe the first fatal case of vedolizumab-associated severe diffuse interstitial lung disease in China.

CASE SUMMARY

We present a case of new-onset diffuse parenchymal lung disease developing under treatment with vedolizumab in a patient with UC. After two doses of vedolizumab, he developed persistent fever and progressively worsening dyspnea. Extensive workups, including bronchoalveolar lavage, transbronchial lung biopsy and metagenomic next-generation sequencing, identified no infectious causes, and other potential causes (such as tumors and cardiogenic pulmonary edema) were also excluded. As a result, a diagnosis of vedolizumab-related interstitial lung disease was established. Unfortunately, although corticosteroids and empiric antibiotics were administered, the patient eventually died of respiratory failure.

CONCLUSION

Vedolizumab-related interstitial lung disease in patients with UC is rare but potentially lethal. Gastroenterologists and pulmonologists should be aware of vedolizumab-related adverse drug reactions.

Keywords: Vedolizumab; Adverse effects; Ulcerative colitis; Inflammatory bowel disease; Interstitial lung disease; Case report

Core Tip: Vedolizumab is the treatment of choice for patients with moderate-to-severe ulcerative colitis who are refractory to tumor necrosis factor antagonists. However, some rare but potentially lethal drug-associated adverse effects warrant pharmacovigilance. We present a case of new-onset diffuse parenchymal lung disease development under treatment with vedolizumab in a patient with ulcerative colitis. After two doses of vedolizumab, he developed persistent fever, progressively worsening dyspnea and eventually died of respiratory failure. The patient was eventually diagnosed with vedolizumab-related interstitial lung disease, in spite of the few case reports found after reviewing the literature. We aim to raise gastroenterologists’ and pulmonologists’ vigilance to this uncommon adverse event.