Hemorrhagic pericardial effusion following treatment with infliximab:A case report and literature review  

作　　者：Hui Li Hui Xing Chen Hu Bai-Yang Sun Shuang Wang Wan-Ying Li Bo Qu 

机构地区：[1]Department of Gastroenterology,The 2nd Affiliated Hospital of Harbin Medical University,Harbin 150086,Heilongjiang Province,China

出　　处：《World Journal of Clinical Cases》2021年第25期7593-7599,共7页世界临床病例杂志

摘　　要：BACKGROUND Infliximab(IFX)is an anti-tumor necrosis factor alpha(TNF-α)agent that is widely used for the management of a variety of autoimmune and inflammatory diseases,including Crohn's disease(CD).As a result of its increasing administration,new complications have emerged.Hemorrhagic pericardial effusion,secondary to IFX therapy,is a rare but life-threatening complication.CASE SUMMARY A 27-year-old man was diagnosed with CD(Montreal A2L3B1)6 years prior.After failing to respond to mesalazine and methylprednisolone,he took the first dose of IFX 300 mg based on his weight(60 kg,dose 5 mg/kg)on December 3,2018.He responded well to this therapy.However,on January 21,2019,1 wk after the third injection,he suddenly developed dyspnea,fever,and worsening weakness and was admitted to our hospital.On admission,computed tomography scan of the chest revealed a large pericardial effusion and a small rightside pleural effusion.An echocardiogram showed a large pericardial effusion and normal left ventricular function.Then successful ultrasound-guided pericardiocentesis was performed and 600 mL hemorrhagic fluid was drained.There was no evidence of infection and the concentrations of TNF-α,IFX,and anti-IFX antibody were 7.09 pg/mL(reference range<8.1 pg/mL),<0.4μg/mL(>1.0μg/mL),and 373 ng/mL(<30 ng/mL),respectively.As the IFX instruction manual for injection does mention pericardial effusion as a rare adverse reaction(≥1/10000,<1/1000),so we discontinued the IFX.Monitoring of the patient’s echocardiogram for 2 mo without IFX therapy showed no recurrence of hemorrhagic pericardial effusion.Follow-up visits and examinations every 3 to 6 mo until April 2021 showed no recurrence of CD or pericardial effusion.CONCLUSION This is a case of hemorrhagic pericardial effusion following treatment with IFX.It is a rare but life-threatening complication of IFX.Early recognition helps prevent the occurrence of hemorrhagic pericardial effusion and minimize the impact on the natural evolution of the disease.

关 键 词：Hemorrhagic pericardial effusion Pericardial complication INFLIXIMAB Crohn's disease Anti-tumor necrosis factor alpha Case report 

分 类 号：R542.12[医药卫生—心血管疾病]