Case report: Eosinophilic pneumonia associated with vedolizumab therapy in a patient with ulcerative colitis

Abstract

Extraintestinal manifestations are common in patients with inflammatory bowel disease, while respiratory involvement is less common. Vedolizumab is a new class of anti-integrin biological agents approved for treating inflammatory bowel disease. In this report, we present the case of a 38-year-old patient with ulcerative colitis for 7 years who developed cough, fever, and pulmonary infiltrates after taking vedolizumab. There was a spontaneous improvement in clinical symptoms and radiological abnormalities after discontinuing vedolizumab and introducing steroids. Despite the rarity of vedolizumab-induced eosinophilic pneumonia, the case reports indicate that patients with unexplained respiratory symptoms that are taking vedolizumab should be fully contemplated.

Keywords: adverse drug reactions; case report; eosinophilic pneumonia; ulcerative colitis; vedolizumab.

FIGURE 1

Computed tomography (CT) scan of the chest. (A) There are lesions of infiltrates under the pleura of the right lung when the patient is admitted. (B) After 2 weeks of antibiotic therapy, countercheck thoracic CT shows that pulmonary infiltrates are not significantly absorbed and appear to spread to the left lung and lower in the right. (C) The infiltrations under the pleura in both lungs were basically absorbed after a mouth of corticosteroid therapy.

FIGURE 2

Pathological changes of lung tissue: microscopic finding of the right lower lung shows a heavy eosinophilic infiltration, > 20 eosinophils per high power field (H and E, ×400).

FIGURE 3

Changes in the condition after vedolizumab (VDZ) therapy. VDZ, vedolizumab; LVEF, levofloxacin; CTX, cefotaxime; CT, computed tomography; EBUS, endobronchial ultrasound.