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Current Drug Safety


ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

Case Report

Bilateral Sub-deltoid Bursitis in a Patient Receiving Infliximab for Crohn's Disease

Author(s): Syrine Bellakhal*, Maissa Abbes, Mohamed Taieb Jomni, Imen Abdelaali, Mehdi Charfi and Mohamed Hedi Douggui

Volume 15, Issue 1, 2020

Page: [77 - 80] Pages: 4

DOI: 10.2174/1574886314666190904115511


Background: Infiximab has been shown to be effective in inducing and maintaining remission of intestinal bowel diseases. Infiximab has been associated with many adverse events. Articular manifestations are commonly reported, but they are of variable clinical expression and aetiology. Among them, inflammatory bursitis has rarely been described.

Objective: Herein a case of inflammatory bursitis in a patient with Crohn’s disease after switching to biosimilar infliximab is reported.

Case Report: A 41-year-old man with Crohn’s disease evolving from 3 years was referred to infliximab therapy at a dose of 5mg/kg because of an aggressive resistant perineal fistula. After 14 infusions of infliximab, the treatment was switched to infliximab biosimilar using the same dose and frequency of administration.

Forty-eight hours after the second infusion, he developed an acute onset of muscle pain and stiffness on both of his shoulders. A musculoskeletal ultrasound was performed and revealed a hypoechoic widening of both subacromial bursae. It was more severe on the left side.

Discussion: The diagnosis of non-infective sub-acromial bursitis secondary to infliximab infusion was made as the patient’s symptoms resolved rapidly without any antibiotics. Infliximab was definitively stopped and adalimumab was introduced.

Conclusion: Musculoskeletal side effects of infliximab infusion are uncommonly reported. Among them, bursitis has been reported in only a few cases. Ultrasonography can help early diagnosis of bursitis. The time of occurring of this reaction regarding infliximab infusion, screening of Antibodies to Infliximab (ATI) and clinical outcome after drug discontinuation are the main helpful arguments.

Keywords: Crohn's disease, infliximab, biosimilar, ultrasonography, bursitis, musculoskeletal side effects.

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Graphical Abstract
Panés J, Rimola J. Perianal fistulizing Crohn’s disease: Pathogenesis, diagnosis and therapy. Nat Rev Gastroenterol Hepatol 2017; 14(11): 652-64.
[] [PMID: 28790453]
Hlavaty T, Letkovsky J. Biosimilars in the therapy of inflammatory bowel diseases. Eur J Gastroenterol Hepatol 2014; 26(6): 581-7.
[] [PMID: 24722561]
The use of the WHO-UMC system for standardised case causality assessment. Available from:
Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30(2): 239-45.
[] [PMID: 7249508]
Mourad AA, Boktor MN, Yilmaz-Demirdag Y, Bahna SL. Adverse reactions to infliximab and the outcome of desensitization. Ann Allergy Asthma Immunol 2015; 115(2): 143-6.
[] [PMID: 26093777]
Malkin J, Shrimpton A, Wiselka M, Barer MR, Duddridge M, Perera N. Olecranon bursitis secondary to Mycobacterium kansasii infection in a patient receiving infliximab for Behcet’s disease. J Med Microbiol 2009; 58(Pt 3): 371-3.
[] [PMID: 19208889]
Veerappan SG, Moinuddin G, Kennedy M, O’Morain CA, Kane D. Early diagnosis of bilateral sub-deltoid bursitis using clinic-based ultrasonography in a patient receiving infliximab therapy for ulcerative pouchitis. Ir J Med Sci 2010; 179(4): 597-8.
[] [PMID: 18949534]
Laine J, Jokiranta TS, Eklund KK, Väkeväinen M, Puolakka K. Cost-effectiveness of routine measuring of serum drug concentrations and anti-drug antibodies in treatment of rheumatoid arthritis patients with TNF-α blockers. Biologics 2016; 10: 67-73.
[] [PMID: 27099470]
Warman A, Straathof JW, Derijks LJ. Therapeutic drug monitoring of infliximab in inflammatory bowel disease patients in a teaching hospital setting: Results of a prospective cohort study. Eur J Gastroenterol Hepatol 2015; 27(3): 242-8.
[] [PMID: 25569569]
Krajcovicova A, Hlavaty T, Zelinkova Z, Letkovsky J, Huorka M. Delayed hypersensitivity reaction after initial dose of infliximab: A case report. Eur J Gastroenterol Hepatol 2014; 26(4): 485-7.
[] [PMID: 24509644]
Scherlinger M, Schaeverbeke T, Truchetet ME. Serum sickness-like disease after switching to biosimilar infliximab. Rheumatology (Oxford) 2017; 56(11): 2032-4.
[] [PMID: 28977481]

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