Recurrent Pneumothorax in a Pediatric Patient with Crohn's Disease Receiving Ustekinumab Treatment: Case Report

Area of Science:

• Gastroenterology
• Pulmonology
• Immunology

Background:

• Crohn's disease is a chronic inflammatory bowel disease.
• Ustekinumab is an immunosuppressive biologic therapy targeting IL-12/23, used for moderate to severe Crohn's disease.
• Pneumothorax is a rare but serious complication associated with certain biologic therapies.

Observation:

• A patient with Crohn's disease developed left-sided pneumothorax two months after initiating intravenous ustekinumab.
• The pneumothorax required surgical intervention and resolved after ustekinumab was discontinued.
• Upon restarting ustekinumab for a Crohn's disease flare one year later, the patient experienced a second episode of pneumothorax.

Findings:

• This case represents the first reported instance of recurrent pneumothorax associated with ustekinumab therapy in a Crohn's disease patient.
• The temporal relationship between ustekinumab initiation and pneumothorax development, along with recurrence upon re-challenge, suggests a potential causal link.
• The atypical presentation and surgical management underscore the severity of this adverse event.

Implications:

• Clinicians should be vigilant for respiratory complications, such as pneumothorax, in Crohn's disease patients treated with ustekinumab.
• This case highlights the importance of considering ustekinumab as a potential trigger for pneumothorax, especially in patients with a history of respiratory issues.
• Further investigation into the mechanisms underlying ustekinumab-induced pneumothorax is warranted to optimize patient safety and treatment strategies.