Retinal vein thrombosis following infliximab treatment for severe left-sided ulcerative colitis

摘要

Here, we describe the development of retinal vein thrombosis in a patient with ulcerative colitis, occurring 2 weeks after his sixth infliximab infusion. Our patient is a 67-year-old man who presented with 6-week history of 20 episodes of bloody diarrhoea per day and weight loss. He had a past medical history of myocardial infarction (1992), and radical radiotherapy for adenocarcinomaof the prostate (completed in July 2005). Colonoscopy revealed continuous severely inflamed ulcerative mucosa involving the rectum, sigmoid colon and descending colon with pseudopolyps seen in the sigmoid colon, in a pattern and distribution consistent with ulcerative colitis. A diagnosis of severe left-sided colitis was made and this was confirmed with histology findings. He was promptly started on mesalazine 2.4 g daily and intravenous hydrocortisone 100 mg every 6 h. Five days after administration of intravenous steroids, he was partially responding to treatment but continued to pass 10 bloody stools per day. Hence the decision was made to commence infliximab therapy. He was given a standard induction regime of 5 mg/kg on a 0-, 2- and 6-week schedule and responded very well. He subsequently became intolerant of mesalazine and was commenced on azathioprine 50 mg once daily. Repeat colonoscopy at this stage revealed almost complete endoscopic resolution of his inflammation. The plan at this stage was to discontinue infliximab once he was on a therapeutic dose of azathioprine, which was titrated up to 175 mg once daily.