Case Report
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World J Nephrol. Aug 6, 2013; 2(3): 90-93
Published online Aug 6, 2013. doi: 10.5527/wjn.v2.i3.90
Acute renal artery occlusion following infliximab infusion
Caroline Lemaitre, Isabelle Iwanicki-Caron, Clément De Vecchi, Nathalie Bertiaux-Vandaële, Guillaume Savoye
Caroline Lemaitre, Isabelle Iwanicki-Caron, Nathalie Bertiaux-Vandaële, Guillaume Savoye, Department of Gastroenterology, Rouen University Hospital, 76031 Rouen, France
Clément De Vecchi, Department of Radiology, Rouen University Hospital, 76031 Rouen, France
Guillaume Savoye, Institut National de la santé et de la recherche médicale (INSERM) U1073, Rouen University Hospital, 76031 Rouen, France
Author contributions: Lemaitre C, De Vecchi C and Bertiaux-Vandaële N contributed to acquisition of data and drafting of the manuscript; Iwanicki-Caron I contributed to acquisition of data, drafting of the manuscript and critical revision; Savoye G contributed to drafting of the manuscript and study supervision
Correspondence to: Guillaume Savoye, MD, PhD, Department of Gastroenterology, Rouen University Hospital, C. Nicolle, ADEN EA 4311, 1 Rue de Germont, 76031 Rouen,France. guillaume.savoye@chu-rouen.fr
Telephone: +33-232-888101 Fax: +33-235-151623
Received: March 12, 2013
Revised: June 27, 2013
Accepted: August 2, 2013
Published online: August 6, 2013
Processing time: 28 Days and 19.8 Hours
Abstract

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.

Keywords: Ulcerative colitis; Acute renal artery occlusion; Infliximab; Anti-tumor necrosis factor agent

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.