Crohn’s Disease with Atypical Extra-Intestinal Manifestations Developing Under Treatment with Vedolizumab

Shtaya, Aasem Abu; Cohen, Shai; Kogan, Yana; Shteinberg, Michal; Sagool, Ori

doi:10.12890/2021_002265

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…In the case described, the condition of the patient improved after steroid treatment, and both β 1+ cells and pulmonary infiltrates progressively disappeared, along with the resolution of clinical symptoms 13 . Similarly, in another case report, a 31‐year‐old patient completely recovered after the withdrawal of VDZ, without the administration of steroids 14 …”

Section: Case Presentationmentioning

confidence: 58%

“…Vedolizumab‐associated pulmonary manifestations are a newly recognized entity, so far described sporadically only in adults, 12–14 which cannot be strictly considered as a classic extra‐intestinal manifestation of IBD. The pathophysiological mechanism for this condition has not been completely elucidated, but a shifted integrin expression profile triggered by VDZ, with an enhanced migration of T lymphocytes to the lungs, has been suggested 12 .…”

Section: Case Presentationmentioning

confidence: 99%

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Vedolizumab‐associated pulmonary manifestations in children with ulcerative colitis

Cucinotta

Dipasquale

Costa

et al. 2021

Clinical Pharmacy Therapeu

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Vedolizumab (VDZ) is a humanized monoclonal antibody and an antiintegrin molecule which interferes with lymphocytes trafficking in the inflamed gastrointestinal tract, therefore reducing immune cell infiltration and local inflammation. 1 In particular, VDZ is characterized by a gut selectivity thanks to its interaction with a4b7-integrin, which is expressed specifically by a subset of gastrointestinalhoming T lymphocytes. Such a blockade prevents the binding of a4b7-integrin-positive leukocytes to the mucosal addressing cell adhesion molecule-1 (Mad-CAM-1) and their translocation from the blood into the inflamed gastrointestinal submucosa. 1 Integrin antagonists represent a relatively new class of therapy and an attractive option for the treatment of inflammatory bowel disease (IBD) as they target different inflammatory pathways in patients who are refractory or intolerant to tumour necrosis factor (TNF)α inhibitors.In addition, they are reported to show reduced systemic side-effects due to gastrointestinal selectivity. 1 Pivotal phase-3, double-blind, placebo-controlled studies, i.e.GEMINI studies 1 and 2, have shown VDZ to be effective in inducing and maintaining clinical remission in adult ulcerative colitis (UC) and Crohn's disease (CD), respectively. 2,3 Based on these results, VDZ has been approved for the treatment of moderate-to-severe CD and UC in patients of 18 years and older who are refractory or intolerant to either conventional treatments or anti-TNFα agents. [3][4][5] The effectiveness and safety of VDZ has been assessed in several real-world studies, displaying promising results both in adult and paediatric settings. 1 Moreover, beyond clinical remission, VDZ has been shown to induce endoscopic and histologic healing, with higher rates in UC than CD. 4,6 Overall rates of adverse events, serious adverse effects, and serious infections were not different between patients treated with placebo and those who received VDZ. 5,7 AEs reported from pooled data of clinical trials were approximately 30.6%, and mostly minor, including myalgia and arthralgia, followed by nasopharyngitis, infection, and skin infections. 8 The exposure-adjusted incidence rates of infections

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Section: Case Presentationmentioning

confidence: 58%

Section: Case Presentationmentioning

confidence: 99%

Vedolizumab‐associated pulmonary manifestations in children with ulcerative colitis

Cucinotta

Dipasquale

Costa

et al. 2021

Clinical Pharmacy Therapeu

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“…Cases of granulomatous lung disease [160,161] and necrobiotic pulmonary nodules in patients with Crohn's disease during treatment with vedolizumab have been described [162]. Rare cases of eosinophilic pneumonia and eosinophilic bronchial asthma in patients with UC under vedolizumab therapy have also been described [163,164].…”

Section: Vedolizumabmentioning

confidence: 99%

Lung Involvement in Inflammatory Bowel Diseases: Shared Pathways and Unwanted Connections

Cavalli,

Gabbiadini,

Dal Buono

et al. 2023

JCM

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Inflammatory bowel diseases (IBDs) are chronic, relapsing inflammatory disorders of the gastrointestinal tract, frequently associated with extraintestinal manifestations (EIMs) that can severely affect IBD patients’ quality of life, sometimes even becoming life-threatening. Respiratory diseases have always been considered a rare and subsequently neglected extraintestinal manifestations of IBD. However, increasing evidence has demonstrated that respiratory involvement is frequent in IBD patients, even in the absence of respiratory symptoms. Airway inflammation is the most common milieu of IBD-related involvement, with bronchiectasis being the most common manifestation. Furthermore, significant differences in prevalence and types of involvement are present between Crohn’s disease and ulcerative colitis. The same embryological origin of respiratory and gastrointestinal tissue, in addition to exposure to common antigens and cytokine networks, may all play a potential role in the respiratory involvement. Furthermore, other causes such as drug-related toxicity and infections must always be considered. This article aims at reviewing the current evidence on the association between IBD and respiratory diseases. The purpose is to raise awareness of respiratory manifestation among IBD specialists and emphasize the need for identifying respiratory diseases in early stages to promptly treat these conditions, avoid worsening morbidity, and prevent lung damage.

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“…The monoclonal antibodies rituximab, omalizumab, ustekinumab, vedolizumab, and natalizumab are suspected causes of pulmonary granulomatosis (130,162,163). Mesalamine has been suggested to induce pulmonary granuloma formation when used to treat Crohn's disease.…”

Section: Other Drug-induced Pulmonary Granulomatous Diseasesmentioning

confidence: 99%

Differential diagnosis of pulmonary sarcoidosis: a review

et al. 2023

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Diagnosing pulmonary sarcoidosis raises challenges due to both the absence of a specific diagnostic criterion and the varied presentations capable of mimicking many other conditions. The aim of this review is to help non-sarcoidosis experts establish optimal differential-diagnosis strategies tailored to each situation. Alternative granulomatous diseases that must be ruled out include infections (notably tuberculosis, nontuberculous mycobacterial infections, and histoplasmosis), chronic beryllium disease, hypersensitivity pneumonitis, granulomatous talcosis, drug-induced granulomatosis (notably due to TNF-a antagonists, immune checkpoint inhibitors, targeted therapies, and interferons), immune deficiencies, genetic disorders (Blau syndrome), Crohn’s disease, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, and malignancy-associated granulomatosis. Ruling out lymphoproliferative disorders may also be very challenging before obtaining typical biopsy specimen. The first step is an assessment of epidemiological factors, notably the incidence of sarcoidosis and of alternative diagnoses; exposure to risk factors (e.g., infectious, occupational, and environmental agents); and exposure to drugs taken for therapeutic or recreational purposes. The clinical history, physical examination and, above all, chest computed tomography indicate which differential diagnoses are most likely, thereby guiding the choice of subsequent investigations (e.g., microbiological investigations, lymphocyte proliferation tests with metals, autoantibody assays, and genetic tests). The goal is to rule out all diagnoses other than sarcoidosis that are consistent with the clinical situation. Chest computed tomography findings, from common to rare and from typical to atypical, are described for sarcoidosis and the alternatives. The pathology of granulomas and associated lesions is discussed and diagnostically helpful stains specified. In some patients, the definite diagnosis may require the continuous gathering of information during follow-up. Diseases that often closely mimic sarcoidosis include chronic beryllium disease and drug-induced granulomatosis. Tuberculosis rarely resembles sarcoidosis but is a leading differential diagnosis in regions of high tuberculosis endemicity.

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Crohn’s Disease with Atypical Extra-Intestinal Manifestations Developing Under Treatment with Vedolizumab

Cited by 5 publications

References 5 publications

Vedolizumab‐associated pulmonary manifestations in children with ulcerative colitis

Vedolizumab‐associated pulmonary manifestations in children with ulcerative colitis

Lung Involvement in Inflammatory Bowel Diseases: Shared Pathways and Unwanted Connections

Differential diagnosis of pulmonary sarcoidosis: a review

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