Gastroenterology

Gastroenterology

Volume 117, Issue 6, December 1999, Pages 1433-1437
Gastroenterology

Case Reports
The relationship between infliximab treatment and lymphoma in Crohn's disease,☆☆

https://doi.org/10.1016/S0016-5085(99)70294-5Get rights and content

Abstract

The relationship between chronic inflammatory conditions and malignancy is complex. We describe the clinical course of 2 patients with Crohn's disease (CD) in whom lymphoma was diagnosed after treatment with infliximab. The first patient was a 61-year-old man with a 30-year history of fistulizing CD in whom B-cell non-Hodgkin's lymphoma was diagnosed 9 months after treatment with infliximab. The second is a 29-year-old man with CD in whom nodular sclerosing Hodgkin's lymphoma was diagnosed 3 weeks after infusion with infliximab. The lymphoma presented with pleural effusions, mediastinal and cervical adenopathy, and no gastrointestinal lesion. We describe the implications of these cases for the use of immunomodulatory therapy in CD and the questionable association between CD and lymphoma.

GASTROENTEROLOGY 1999;117:1433-1437

Section snippets

Case reports

Patient 1 was a 62-year-old white man who had a 30-year history of ileocolic CD complicated by perianal fistulas. He required multiple resections, leaving him with an ileorectal anastomosis. He was maintained on therapy with azathioprine, 50–150 mg daily, and concurrent prednisone, 5 mg daily, for 9 years. He had no known extraintestinal manifestations of inflammatory bowel disease (IBD). His medical history was notable for episodic tracheobronchitis in the past and nephrolithiasis in 1981. He

Discussion

Lymphomas, including HD, are not considered common in patients with CD. In fact, HD in CD is extremely rare, with only 10 cases previously reported in the medical literature. Of these 10, 4 cases were of the nodular sclerosing subtype,2, 3, 4, 5 3 showed mixed cellularity (1 of which was suggestive of high-grade NHL after further histological review),6, 7, 8 and 3 were not classified further (Table 2).9, 10, 11

. Previously reported cases of lymphoma developing among individuals with CD

Type of

Acknowledgements

Drs. Bickston and Lichtenstein share first authorship of this article.

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    Address requests for reprints to: Fabio Cominelli, M.D., Ph.D., Division of Gastroenterology and Hepatology, University of Virginia Health System, Box 10013, Charlottesville, Virginia 22906-0013. e-mail: [email protected]; fax: (804) 243-6405.

    ☆☆

    Dr. Cohen has worked as a consultant to Centocor, Inc. Dr. Cominelli has a grant from Centocor, Inc., to study the incidence of lymphoma among hospitalized patients with Crohn's disease. He is also a member of the speaking bureau for Centocor, Inc. Drs. Cominelli and Bickston are currently clinical trial investigators of CDP571 (CellTech Therapeutic Ltd., Berkshire, England).

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