Background:
Immunosuppressive therapy with anti-tnf-alpha antibodies is effective in patients with inflammatory bowel disease (ibd). however, there is an increased risk for infections associated with this therapy.
Methods:
Here, we report the case of a 58-year-old patient with crohn's disease (cd) treated with steroids and azathioprine who developed severe legionella pneumophila pneumonia after 3 infusions of infliximab. the patient presented at our ibd department with severe active cd complicated by inflammatory small bowel stenoses and entero-enteral fistulas despite long-term high-dose steroid therapy. to achieve steroid tapering and control of disease activity, immunosuppressive therapy with azathioprine was initiated. due to persistent symptoms, infusion therapy with the anti-tnf-alpha antibody infliximab was started, subsequently leading to significant clinical improvement. however, after the third infliximab infusion the patient was hospitalized with fever, severe fatigue, and syncope.
Results:
Laboratory findings and chest x-ray revealed left-sided pneumonia; cultural analysis showed l. pneumophila serogroup 1 leading to respiratory insufficiency, which required mechanical ventilation for 2 weeks in the intensive care unit. after discontinuation of all immunosuppressive agents and immediate antibiotic therapy the patient recovered completely.
Conclusions:
To our knowledge, this is the third case of l. pneumophila pneumonia in an ibd patient treated with infliximab. similar to other published cases, concomitant treatment of immunosuppressives and anti-tnf agents is a major risk factor for the development of l. pneumophila infection, which should be ruled out in all cases of pneumonia in patients with such a therapeutic regimen. appropriate prevention strategies should be provided in these patients.