Case report, case study
https://doi.org/10.3325/cmj.2021.62.634
Infliximab rescue therapy in a patient with acute severe ulcerative colitis and coronavirus disease 2019 followed by Escherichia coli 0157:H7 infection: a case report
Dinko Bekić
orcid.org/0000-0002-2941-4472
; Department of Gastroenterology and Hepatology, Sveti Duh University Hospital, Zagreb, Croatia
Željka Belošić Halle
; Department of Gastroenterology and Hepatology, Sveti Duh University Hospital, Zagreb, Croatia
Abstract
The management of patients with acute severe ulcerative
colitis and SARS-CoV-2 presents a clinical challenge. We
report on the first case of a patient with acute severe ulcerative colitis and mild coronavirus disease 2019 (COVID19) who received rescue infliximab therapy, followed by
a relapse caused by enterohemorrhagic Escherichia coli
0157:H7. The treatment challenges we faced were biologic therapy administration during active COVID-19, about
which little was known at the time, and how to treat EHEC
due to the risk of hemolytic uremic syndrome. Acute severe ulcerative colitis was treated with rescue infliximab
therapy, and enteric infection with an antibiotic, both with
satisfactory clinical response. The decision to induce biologic therapy for inflammatory bowel disease relapse in
SARS-CoV-2-positive patients should be made on a caseto-case basis and should be driven by the dominant disease. Our patient tested positive for SARS-CoV-2, but actually had mild disease. At the same time, she had acute
severe ulcerative colitis, so we started anti-tumor necrosis
factor therapy despite serological tests and the recommendation to delay biological therapy administration for
two-weeks. Second, due to severity of the first flare, COVID-19, and the patient’s general condition, we opted for an
antibiotic treatment of Escherichia coli 0157:H7 while monitoring the parameters of potential hemolytic uremic syndrome development
Keywords
Hrčak ID:
278875
URI
Publication date:
23.12.2021.
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