Yeungnam Univ J Med.  2021 Jul;38(3):251-257. 10.12701/yujm.2020.00878.

Successful treatment with vedolizumab in an adolescent with Crohn disease who had developed active pulmonary tuberculosis while receiving infliximab

• Choi S
• Choi BS
• Choe BH
• Kang B

• KMID: 2518669
• DOI: http://doi.org/10.12701/yujm.2020.00878

Abstract

Vedolizumab (VDZ) has been approved for the treatment of inflammatory bowel diseases (IBDs) in patients aged ≥18 years. We report a case of a pediatric patient with Crohn disease (CD) who was successfully treated with VDZ. A 16-year-old female developed severe active pulmonary tuberculosis (TB) during treatment with infliximab (IFX). IFX was stopped, and TB treatment was started. After a 6-month regimen of standard TB medication, her pulmonary TB was cured; however, gastrointestinal symptoms developed. Due to the concern of the patient and parents regarding TB reactivation on restarting treatment with IFX, VDZ was started off-label. After the second dose of VDZ, the patient was in clinical remission and her remission was continuously sustained. Ileocolonoscopy at 1-year after VDZ initiation revealed endoscopic healing. Therapeutic drug monitoring conducted during VDZ treatment showed negative antibodies to VDZ. No serious adverse events occurred during the VDZ treatment. This is the first case report in Korea demonstrating the safe and effective use of VDZ treatment in a pediatric CD patient. In cases that require recommencement of treatment with biologics after recovery of active pulmonary TB caused by anti-tumor necrosis factor agents, VDZ may be a good option even in pediatric IBD.

Keyword

Child; Inflammatory bowel diseases; Infliximab; Tuberculosis; Vedolizumab

Figure

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  Fig. 1. Images of ileocolonoscopy at the diagnosis of Crohn disease. Multifocal aphthous ulcers are observed in the (A) terminal ileum and (B) colon.

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  Fig. 2. Images at the diagnosis of Crohn disease. (A) Upper gastrointestinal endoscopy shows multiple ulcers in the duodenum. (B) Magnetic resonance enterography shows multisegmental wall thickening in the ileum.

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  Fig. 3. Radiologic images at the diagnosis of active pulmonary tuberculosis during infliximab treatment. (A) Chest X-ray shows a marked amount of left pleural effusion. (B) Chest computed tomography shows left pleural effusion with mild pleural thickening and nodularities.

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  Fig. 4. Images of ileocolonoscopy before and after treatment with vedolizumab. (A) Multiple ulcers with mucosal friability are observed throughout the colon before treatment with vedolizumab. (B) Endoscopic healing is observed 1 year after treatment with vedolizumab.

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  Fig. 5. Fecal immunochemical test (FIT) and fecal calprotectin (FC) results during vedolizumab treatment.

Reference

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