Pulmonary Eosinophilia Following Infliximab Treatment for Crohn's Disease.

An 18-year-old woman with a history of asthma and Crohn’s disease of the terminal ileum and colon with prior perirectal abscess, who was on azathioprine and infliximab (Remicade, Centocor) therapy, presented with sore throat, fevers, dyspnea, and nonproductive cough 2 weeks after her third infusion of infliximab. Laboratory studies demonstrated a peripheral eosinophilia of 29% and chest radiograph and computed tomography scan revealed bilateral diffuse infiltrates. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy showed interstitial and intra-alveolar eosinophilic infiltrates consistent with an eosinophilic pneumonia. Infectious etiologies were ruled out. The patient was treated with a short corticosteroid taper and symptoms, eosinophilia, and infiltrates resolved. Infliximab therapy was discontinued but she was maintained on azathioprine therapy. At 19 months follow-up, she remains without pulmonary symptoms, and eosinophil count is 1%. Infliximab has been associated with an eosinophilic reaction in two previous reports. Clinicians should be aware of the possible association between infliximab infusion and pulmonary eosinophilia.

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