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Large paraspinal abscess as a complication of infliximab therapy in Crohn's disease

Nishani Nithianandan1, Michael J Loftus2, Paul D R Johnson2,3

  • 1Department of General Medicine, Austin Health, Heidelberg, Victoria, Australia.

BMJ Case Reports
|May 1, 2019
PubMed

Insights

A man on infliximab for Crohn's disease developed a large epidural and paraspinal abscess caused by Staphylococcus aureus. Treatment involved drainage, antibiotics, and pausing infliximab.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Neurosurgery

Background:

  • Infliximab is a biologic therapy used for Crohn's disease.
  • Immunosuppression from infliximab can increase infection risk.

Observation:

  • A 36-year-old man on infliximab for Crohn's disease developed a large epidural and paraspinal abscess.
  • The abscess culture identified methicillin-susceptible Staphylococcus aureus.

Findings:

  • Treatment included surgical drainage, antibiotics (flucloxacillin), and temporary discontinuation of infliximab.
  • This is the first reported case of a large paraspinal abscess with epidural extension as a complication of infliximab therapy.

Implications:

  • Clinicians should be vigilant for serious infections, including spinal abscesses, in patients receiving infliximab.
  • Early recognition and management are crucial for favorable outcomes in such cases.
Keywords:
bone and joint infectionscrohn’s diseaseinfection (neurology)infections

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