Leukocytoclastic Vasculitis Secondary to Anti-Tumor Necrosis Factor Therapy in Inflammatory Bowel Diseases: A Multicenter Retrospective Cohort Study

Rogério Serafim Parra; Júlio Maria Fonseca Chebli; Liliana Andrade Chebli; Sérgio Figueiredo de Lima Junior; Manoel Alvaro Lins Neto; Terry Rocha de Medeiros; Francesca Maia Faria; Marley Ribeiro Feitosa; Cintia Maura Caseiro Nigro; Omar Féres

doi:10.3390/jcm12093165

Leukocytoclastic Vasculitis Secondary to Anti-Tumor Necrosis Factor Therapy in Inflammatory Bowel Diseases: A Multicenter Retrospective Cohort Study

J Clin Med. 2023 Apr 28;12(9):3165. doi: 10.3390/jcm12093165.

Affiliations

¹ Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil.
² Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil.
³ General and Digestive Surgery Service, João de Barros Barreto University Hospital, Belém 66073-000, Brazil.
⁴ Department of Gastrointestinal Surgery, Federal University of Alagoas-UFAL, Maceió 57051-090, Brazil.
⁵ Hospital Professor Edmundo Vasconcelos, São Paulo 04038-905, Brazil.
⁶ Department of Pathology and Forensic Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14048-900, Brazil.

Abstract

Background: Vasculitis is an uncommon complication of biologics used to treat inflammatory bowel disease (IBD). This study describes a case series of vasculitis induced by anti-tumor necrosis factor (TNF) therapy in IBD patients.

Methods: Retrospective assessments were performed using the medical records of adult IBD patients who underwent outpatient clinical follow-ups between January 2010 and December 2019 in order to identify patients with vasculitis caused by anti-TNF therapy.

Results: There were 2442 patients altogether. Of these, 862 (35%) took anti-TNF medication. Five patients (0.6% of the overall patients; n = 3 (60%) Crohn's disease; n = 2 (40%), ulcerative colitis) were identified as having leukocytoclastic vasculitis (LCV) due to anti-TNF therapy; these patients were white, female, and non-smokers. The mean age of LCV diagnosis was 32.2 years, and the mean IBD duration was 7.2 years. The mean time between the start of biologic therapy and LCV onset was 30.8 months. Most of the patients were using adalimumab (80%; n = 4). All the patients were in remission at the time of the LCV diagnosis, and the vasculitis affected the skin in all cases. Anti-TNF therapy was discontinued in the five abovementioned patients, and the response of LCV to the oral steroids was significantly positive. Remarkably, all five patients experienced complete remission from LCV within 4-12 weeks after starting prednisone therapy, and none of them had LCV recurrence in the follow-up period (a mean duration of 28 months).

Conclusions: LCV is an unusual complication of anti-TNF therapy in the IBD setting. In this context, clinicians should have a high degree of suspicion of LCV in patients who develop an unexplained cutaneous rash.

Keywords: Crohn’s disease; biologic therapy; inflammatory bowel disease; ulcerative colitis; vasculitis.

Grants and funding

This research was supported by the Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (FAEPA).