Letters To The Editor
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2015; 21(7): 2260-2262
Published online Feb 21, 2015. doi: 10.3748/wjg.v21.i7.2260
Adalimumab-induced interstitial pneumonia in a patient with Crohn’s disease
María José Casanova, María Chaparro, Claudia Valenzuela, Carolina Cisneros, Javier P Gisbert
María José Casanova, María Chaparro, Javier P Gisbert, Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), CP 28002 Madrid, Spain
Claudia Valenzuela, Carolina Cisneros, Pneumology Department, Hospital Universitario de La Princesa, CP 28002 Madrid, Spain
Author contributions: Casanova MJ wrote this letter; and Chaparro M, Valenzuela C, Cisneros M and Gisbert JP critically revised it.
Supported by CIBEREHD is founded by Instituto de Salud Carlos III.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: María José Casanova, MD, PhD, Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Canillas, 70 2º-G, CP 28002 Madrid, Spain. mjcasanova.g@gmail.com
Telephone: +34-9-13093011 Fax: +34-9-14022299
Received: July 6, 2014
Peer-review started: July 7, 2014
First decision: August 6, 2014
Revised: September 21, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: February 21, 2015
Abstract

There are several reports of anti-tumor necrosis factor (TNF)-induced lung disease, especially in patients with rheumatologic diseases. Adalimumab is an anti-TNF drug used to induce and maintain remission in patients with immune-mediated diseases, such as Crohn’s disease. Although pulmonary disorders could be an extra-intestinal manifestation of inflammatory bowel disease, biologic therapy could also be a cause of lung injury. Only few cases of adalimumab-induced lung toxicity have been reported, and the majority of them were in patients with rheumatologic diseases. Lung injury secondary to anti-TNF therapy should, after ruling out other etiologies, be considered in patients who have a temporal association between the onset of respiratory symptoms and the exposure to these drugs. A compatible pattern in the biopsy and the clinical improvement after discontinuation of the anti-TNF drug would strongly support the diagnosis.

Keywords: Adalimumab, Anti-tumor necrosis factor, Crohn’s disease, Interstitial pneumonia

Core tip: Lung injury secondary to anti-tumor necrosis factor (TNF) drugs could cause severe respiratory symptoms in patients exposed to this therapy, and it should be suspected in patients who: have a temporal association between the onset of respiratory symptoms and the exposure to anti-TNF drugs, show a compatible pattern in the biopsy, and offer negative results for infection. There are a few cases reported of adalimumab-lung toxicity in patients with inflammatory bowel disease. Clinical improvement after biologic therapy discontinuation strongly supports the diagnosis. The mechanism by which anti-TNF drugs induce lung injury remains unclear; therefore, the use of another anti-TNF drug should be discouraged.