Posterior Reversible Encephalopathy Syndrome After Infliximab Infusion for Fistulizing Crohn's Disease

Area of Science:

• Neurology
• Gastroenterology
• Immunology

Background:

• Biologic therapies, such as infliximab, are crucial for managing complex inflammatory bowel diseases (IBD).
• These advanced treatments, while effective, carry potential risks, including rare but serious adverse events.
• Posterior reversible encephalopathy syndrome (PRES) is a recognized neurological complication associated with certain medications.

Observation:

• A 19-year-old woman with fistulizing Crohn's disease developed PRES while undergoing infliximab treatment.
• Her PRES symptoms included recurrent seizures and hypertension.
• The patient experienced a full neurological recovery with supportive care, including antiepileptic and antihypertensive medications.

Findings:

• This case represents one of fewer than 10 reported instances of PRES linked to biologic therapy in IBD patients.
• The patient's PRES resolved, and she was able to resume infliximab therapy without recurrence.
• Diagnosis of PRES relies on characteristic clinical presentation and neuroimaging findings.

Implications:

• Clinicians should maintain a high index of suspicion for PRES in IBD patients receiving biologic agents.
• Early recognition and supportive management are key to favorable outcomes in medication-induced PRES.
• This case underscores the complex risk-benefit profile of biologic therapies in IBD management.