Ustekinumab associated chronic eosinophilic pneumonia

Kalra, Saminder; Chizinga, Mwelwa; Trillo-Alvarez, Cesar; Papierniak, Eric S.

doi:10.1080/02770903.2020.1827416

Cited by 5 publications

(6 citation statements)

References 8 publications

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“…The pulmonary manifestations described in these patients included interstitial pneumonia (7 patients), organizing pneumonia (1 patient), eosinophilic pneumonia (3 patients), and hypersensitivity pneumonitis (1 patient) based on a combination of imaging, BAL findings, and/or lung biopsy [ 5 ]. Another case report by Kalra describes a patient with Crohn’s disease who developed dry cough and dyspnea that progressed between the first and second doses of ustekinumab, and was subsequently diagnosed with chronic eosinophilic pneumonia based on imaging findings and BAL with 67% eosinophils [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the case series by Brinker, 5 patients received steroids, 2 patients received antibiotics, 1 patient received cough suppressants, while six patients were treated with discontinuation of medication alone [ 5 ]. Ustekinumab has a long half-life, and therefore in addition to avoidance of further doses, the addition of steroids has been used to potentially hasten recovery [ 6 ]. As in our case, in the case report by Kalra, medication cessation and a prolonged steroid taper led to resolution of symptoms and imaging findings [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ustekinumab has a long half-life, and therefore in addition to avoidance of further doses, the addition of steroids has been used to potentially hasten recovery [ 6 ]. As in our case, in the case report by Kalra, medication cessation and a prolonged steroid taper led to resolution of symptoms and imaging findings [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Stelara struck: a case of noninfectious pneumonitis secondary to ustekinumab

Despotes

Vigeland

2022

BMC Pulm Med

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Background We describe a case of acute hypoxic respiratory failure due to drug induced lung disease secondary to ustekinumab, which is a monoclonal antibody used to treat psoriasis, psoriatic arthritis, and inflammatory bowel disease. Case presentation A 33-year-old man with a history of Crohn’s disease presented with fevers, myalgias, and abdominal pain, and subsequently developed acute hypoxemic respiratory failure approximately 2 weeks after restarting ustekinumab for his Crohn’s disease. Cross-sectional chest imaging showed ground glass opacities and bilateral consolidations. Due to progressive hypoxia, he ultimately required intubation and mechanical ventilation. Broad infectious and autoimmune work up was negative, making drug induced interstitial lung disease (DILD) the leading consideration. He was treated with high dose steroids with dramatic improvement in his respiratory status. At follow up, his imaging findings had largely resolved, and his pulmonary function tests were normal. Conclusions For patients presenting with acute hypoxic respiratory failure, it is critical to identify the underlying cause. In addition to testing for common respiratory infections that can cause respiratory failure, patients should also be evaluated for risk factors for developing atypical or opportunistic infections as well as inflammatory pneumonitis. Due to receiving ustekinumab, our patient was both at risk for developing an opportunistic infection as well as DILD. Although rare, DILD is a recognized toxicity of ustekinumab. Ustekinumab can cause significant lung injury, as in our patient, but with steroids and avoidance of future doses of the medication, our patient demonstrated good recovery. Reassuring outcomes have similarly been described in the literature; however, this case provides further details about outcomes with long-term follow-up clinical, imaging, and pulmonary function testing data available. We recommend consideration of high dose steroids for these patients for whom DILD is suspected.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Stelara struck: a case of noninfectious pneumonitis secondary to ustekinumab

Despotes

Vigeland

2022

BMC Pulm Med

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“…9 In the time since ustekinumab was approved for use by the US Food and Drug Administration, approximately six cases of eosinophilic pneumonia have been reported in the literature. 10 Most cases are diagnosed based on clinical features and the timing of drug administration and development of symptoms, which is usually 1 to 2 months after exposure. 10 Our patient developed hypoxemic respiratory failure secondary to acute eosinophilic pneumonia after his first exposure to ustekinumab, strongly suggesting this as the etiology.…”

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confidence: 99%

“…10 Most cases are diagnosed based on clinical features and the timing of drug administration and development of symptoms, which is usually 1 to 2 months after exposure. 10 Our patient developed hypoxemic respiratory failure secondary to acute eosinophilic pneumonia after his first exposure to ustekinumab, strongly suggesting this as the etiology. Ustekinumab has also been associated with hypersensitivity pneumonitis and interstitial lung disease with a granulomatous component.…”

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confidence: 99%

61-Year-Old Man With Shortness of Breath and Cough

Colbenson

Olson

Nelson

2021

Mayo Clinic Proceedings

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61-year-old man presented with 3 weeks of shortness of breath and cough productive of occasional brown sputum. His medical comorbidities included Crohn colitis, deep vein thrombosis and pulmonary embolism on chronic anticoagulation, obstructive sleep apnea, obesity, impaired fasting glucose, depression, and latent tuberculosis status post 9 months of isoniazid. For the past year, his Crohn disease treatment regimen included methotrexate, and he received his first dose of ustekinumab 6 weeks before presentation. He was also being treated with an albuterol inhaler as needed, citalopram, folic acid, metformin, warfarin, and iron supplementation. He was diagnosed with community-acquired pneumonia 2 weeks prior and subsequently treated with levofloxacin. However, after finishing antibiotics he was still feeling unwell and had home oximeter readings in the low 80s. On physical exam at the time of presentation, he was alert and oriented and responding appropriately to questions. He had dry oral mucosa, regular rate and rhythm without murmurs, and no lower-extremity edema on cardiac exam. He was noted to be tachypneic and had bibasilar and right midfield crackles, but no significant respiratory distress at rest. His abdomen was soft and nontender. There were no motor or sensory abnormalities noted. Initial laboratory values showed an elevated lactate of 3.2 mmol/L (0.5-2.2 mmol/L), leukocytosis of 13.9Â10 9 /L (3.4-9.6Â10 9 /L), eosinophilia of 1.21Â10 9 /L (0.03-0.48Â10 9 /L), elevated C-reactive protein of 205 mg/L ( 8 mg/L) and erythrocyte sedimentation rate of 40 mm/1 h (0-22 mm/1 h). Chest radiograph revealed consolidation throughout the left mid and lower lung with new consolidation in the right upper lung and right lower lung.

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Ustekinumab

2022

Reactions Weekly

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Ustekinumab associated chronic eosinophilic pneumonia

Cited by 5 publications

References 8 publications

Stelara struck: a case of noninfectious pneumonitis secondary to ustekinumab

Stelara struck: a case of noninfectious pneumonitis secondary to ustekinumab

61-Year-Old Man With Shortness of Breath and Cough

Ustekinumab

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