Tumour necrosis factor inhibitors have revolutionised the management of Crohn’s disease, but reports of a possible association between concomitant infliximab and immunomodulator therapy and hepatosplenic T-cell lymphoma (a rare form of aggressive non-Hodgkin’s lymphoma) have emerged. We describe the first case in Australia of hepatosplenic T-cell lymphoma in a patient who had been treated with infliximab and immunomodulators for Crohn’s disease.
In January 2006, a 39-year-old man of European background presented with severe sepsis of unidentified source. This was complicated by hypotension and multiorgan failure, including renal impairment, abnormal liver function and myocardial injury, and he required intensive care. He had a 13-year history of active perianal and ileal Crohn’s disease, which had been treated with prednisolone (varying doses) continuously from 1993, and with azathioprine (2–2.5 mg/kg) from 1993 to 1994 and then continuously from August 1999 (after drainage of a perianal abscess). He had also received three doses of infliximab (5 mg/kg) between November 1999 and January 2000, which achieved a partial response. Azathioprine and prednisolone therapy were continued after infliximab therapy, with relatively good control of symptoms. Results of full blood examinations during azathioprine therapy were within normal ranges. On admission, azathioprine therapy was discontinued, but corticosteroids were continued.
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