ABSTRACT
Aim To report the first case of cardiac tamponade related to Infliximab induction therapy in an Ulcerative Colitis patient. Methods Review of published case reports. Results This complication was likely due to a type 3 hypersensitivity immune-complex reaction resulting in a reactive pericardial effusion Discussion Though rare, this case demonstrates how autoimmune reaction to anti-TNFð¼ therapy can initially mimic infection, as our patient presented with tachycardia, hypotension, raised inflammatory and infective markers and fever.
Subject(s)
Cardiac Tamponade/chemically induced , Colitis, Ulcerative/drug therapy , Gastrointestinal Agents/adverse effects , Infliximab/adverse effects , Autoimmunity , Cardiac Tamponade/diagnosis , Cardiac Tamponade/immunology , Cardiac Tamponade/therapy , Colitis, Ulcerative/immunology , Female , Gastrointestinal Agents/administration & dosage , Gastrointestinal Agents/immunology , Humans , Infliximab/administration & dosage , Infliximab/immunology , Middle Aged , Pericardial Effusion/chemically induced , Pericardial Effusion/diagnosis , Pericardial Effusion/immunology , Pericardial Effusion/therapy , Treatment Outcome , Tumor Necrosis Factor-alpha/immunologySubject(s)
Ampicillin/analogs & derivatives , Glucocorticoids/administration & dosage , Granuloma/pathology , Hepatitis , Immunocompromised Host , Q Fever/complications , Ampicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Biopsy/methods , Coxiella burnetii/isolation & purification , Diagnosis, Differential , Early Medical Intervention/methods , Female , Hepatitis/drug therapy , Hepatitis/etiology , Hepatitis/pathology , Humans , Liver Function Tests/methods , Middle Aged , Q Fever/diagnosis , Q Fever/microbiology , Treatment OutcomeABSTRACT
BACKGROUND: The availability of double-balloon enteroscopy (DBE) and small bowel capsule endoscopy (SBCE) in Ireland has revolutionised our approach to the diagnosis and treatment of small bowel disorders. AIMS: To evaluate the use of DBE in Ireland and to compare the diagnostic yield with and without prior SBCE in order to improve the efficiency of our resources for small bowel endoscopy. METHODS: A retrospective comparison study of all DBEs performed between two centres, one with SBCE available, was undertaken. Information was obtained by review of endoscopy reports, referral letters, radiology reports and charts. A review of the SBCE database was undertaken to identify patients who had undergone SBCE prior to DBE. RESULTS: A total of 242 DBE procedures were carried out between both centres. SBCE was performed prior to DBE in 20 % (n = 46). The overall diagnostic yield of DBE was 47 % (n = 115). There was a statistically significant difference in diagnostic yield between the DBE only and the DBE with prior SBCE groups 44 versus 61 %, respectively, p < 0.0001. There was also a significant difference in the DBE approach, with 73 % of procedures being anterograde in centre 1 versus 56 % in centre 2. A subgroup analysis of centre 1 data revealed a negative predictive value of 100 % and a positive predictive value of 74 % for SBCE when DBE findings were considered as a gold standard. CONCLUSION: SBCE as a screening tool prior to DBE is extremely valuable and increases the diagnostic yield considerably as a consequence of a high negative predictive value.
