Revised: June 27, 2013
Accepted: August 2, 2013
Published online: August 6, 2013
We report the case of a 44-year-old male patient who presented with acute renal artery occlusion, 3 d after first injection of infliximab for steroid refractory attack of ulcerative colitis. Extensive work-up provided no evidence of predisposing factors for arterial thrombosis. Infliximab was thus suspected in the genesis of thrombosis, based on both intrinsic and extrinsic criteria. At month 3 after thrombosis with ongoing anticoagulation, angio-tomodensitometry showed complete revascularization of the left renal artery with renal atrophy. Renal function remained normal and the patient was still in steroid free remission on mercaptopurin monotherapy at maximal follow-up. Few thromboembolic events have been described with anti- tumor necrosis factor (TNF) agents, but it is the first case reported of renal artery thrombosis after infliximab infusion. In addition, we review thrombosis associated with anti-TNF agents.
Core tip: To the best of our knowledge, it is the first case reported of renal artery thrombosis after infliximab infusion. Evidence for drug induced toxicities are usually lacking and the diagnosis in our patient was based on both intrinsic and extrinsic criteria in favour of a direct consequence of infliximab administration. In the literature, only few reports have been published on arterial or venous thrombosis with these drugs. The arterial thrombosis are unusual and are mostly myocardial infarction or cerebrovascular accident. Renal arterial thrombosis in patient receiving infliximab is possible and clinician should be aware of this challenging unusual condition.