Crohn's colitis presenting with node-negative colon cancer and liver metastasis after therapy with infliximab: report of two cases

Colon cancer after infliximab therapy for Crohn's disease

Infliximab is an effective agent in the treatment of patients with Crohn's disease. Therapy with infliximab is generally well tolerated but there are concerns about its effects on the incidence of cancer. This case report refers to a 47-year-old patient with long-standing Crohn's disease, without a family history of colorectal cancer, who had a previous diagnosis of low-grade dysplasia that was not confirmed in subsequent studies, and was diagnosed with adenocarcinoma of the colon with peritoneal invasion after the fourth infusion of infliximab.

Mucinous carcinoma in Crohn’s disease originating in a fistulous tract

Malignant disease, including mucinous carcinomas of the colorectum, may complicate long-standing Crohn’s disease. An 18-year-old male with extensive small and large bowel involvement with Crohn’s disease developed recurrent peri-rectal fistulous disease that persisted for more than a decade despite pharmacological and surgical therapy as well as later therapy with biological agents. Eventually, an extensive and difficult-to-detect mucinous carcinoma developed in the fistulous tract. Although fistula cancer is rarely described in Crohn’s disease, use of immunosuppressant and biological agents may play an initiating or exacerbating role in its development or progression. As potent biological agents are frequently used, often to avoid surgical treatment, clinicians should have an increasingly high index of suspicion for this potential complication, especially if fistulous drainage persists and remains refractory to medical therapy.

Drug-induced hepatitis and lupus during infliximab treatment for psoriasis: case report and literature review

BACKGROUND

Infliximab (IFX) can induce elevation of hepatic aminotransferase levels. Hepatitis has been reported in patients treated with IFX and with risk factors such as viral hepatitis, alcohol intake, or concomitant use of hepatotoxic drugs. Liver disorders occurring in a patient without risk factors have rarely been reported, and liver biopsies to substantiate the liver changes have very rarely been described. The presence of lupus-like symptoms with newly positive antinuclear antibodies (ANAs), sometimes with double-stranded deoxyribonucleic acid (DNA) antibodies, has also been reported with IFX. Only a few articles have reported in detail these types of adverse events in patients with psoriasis. To our knowledge, the combination of lupus-like symptoms with simultaneous occurrence of a biopsy-proven hepatitis has not been reported with the use of IFX for psoriasis.

OBJECTIVE

Description of a case of drug-induced hepatitis in a patient with concurrent clinical and serologic features of lupus induced by IFX.

METHODS

We present the case of a 40-year-old woman with psoriasis who developed a biopsy-proven drug-induced hepatitis and concurrent lupus symptoms with positive ANAs while under IFX treatment. A review of related publications is presented.

CONCLUSION

The clinician must be aware of uncommon side effects of IFX, such as liver anomalies and development of autoantibodies. Liver enzymes should be monitored regularly, and ANAs should be checked if liver enzymes are increasing and in the presence of lupus symptoms.

Treatment with biologic therapies and the risk of cancer in patients with IBD

The proven involvement of cytokines in the pathophysiology of IBD has led to the development of powerful, selective, anticytokine drugs--so-called biologics--as a therapy for IBD. Although the efficacy of infliximab, a chimeric monoclonal IgG1 antibody directed against tumor necrosis factor, is proven and the use of biologic agents is growing worldwide, there is concern about their long-term safety, which includes the risk of developing cancer. An increased risk of malignancies, particularly lymphoma, has been reported in some studies of infliximab-treated patients with IBD; however, the increased risk could be caused by the underlying chronic disease, severity of the disease, concomitant medications (e.g. conventional immunomodulators), infliximab itself, or all of these variables. At present, the data do not provide clear evidence for a causal association between infliximab and the increased cancer risk. In appropriately selected patients with severe, refractory Crohn's disease, the benefits of biologic therapy seem to outweigh the cancer risk. Multicenter, case-control studies in large populations, with a long-term follow-up are needed to define the outcome of patients with IBD treated with biologic therapies.

Atypical carcinoid tumor of the thymus with ectopic ACTH production developed during the course of etanercept treatment—case report

Ever since the introduction of anti-tumor necrosis factor (TNF) agents, concerns have been raised regarding their potential for developing malignancy. We report the development of thymic atypical carcinoid tumor 9 months after the initiation of etanercept therapy in a patient having refractory spondylarthritis. This case indicates the need for following large cohorts of patients receiving anti-TNF agents to address the long-term effect of these agents on malignancies.