Síndrome lupus-like induzida pelo uso do infliximabe em paciente portador de doença inflamatória intestinal

Abstract

Inflammatory bowel diseases (IBD) are immune-mediated disorders of the digestive tract whose treatment may include anti-TNF alpha. It is known that these drugs can cause autoimmune disorders, ranging from the induction of autoantibodies to more serious autoimmune diseases, such as the lupus-like syndrome, which is uncommon and poorly described in the literature. In this study, a case of 29-year-old female patient with Fistulizing Crohn’s Disease was presented, who after 1 year and 5 months of use of infliximab developed peripheral arthritis in joints of the hands, wrists and knees and, after 5 months, malar rash and photosensitivity. The ANA dosage was 1: 640, homogeneous pattern and C4 was reduced. In this context, the lupus-like syndrome induced by the use of anti-TNF alpha was suspected, and prednisone was started, and infliximab was replaced by adalimumab. After that, the symptoms resolved. There are no specific diagnostic criteria for drug-induced lupus and patients usually develop cutaneous-articular symptoms and autoantibodies positive, with clinical improvement after drug withdrawal. It is controversial whether another anti-TNF alpha or a biological of another class should be restarted, and further studies on the safety of these drugs are needed in patients who have developed lupus-like syndrome.