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Infliximab rescue therapy in a case of severe granulomatous colitis associated with rituximab use
  1. Pablo Martinez Perez,
  2. Luke Hanna,
  3. Eleanor Jaynes and
  4. Markus Gwiggner
  1. University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr Pablo Martinez Perez; pablo.perez{at}


Colitis occurs in about 4% of individuals treated with rituximab. Optimal management of rituximab-induced colitis, which does not improve with cessation of the drug and supportive care alone, is poorly defined due to limited evidence. Severe refractory disease can lead to colectomy. We present a case of suspected rituximab-induced colitis occurring in a woman in her 70s suffering from rheumatoid arthritis. The patient achieved full clinical, endoscopic and histological remission of colitis with infliximab therapy. The use of biological therapy to treat rituximab-induced colitis can be a potentially organ-saving rescue therapy; however, it must be balanced against the increased risks of immunosuppression in patients already exposed to rituximab. While more evidence is required to fully understand the efficacy and risks of antitumour necrosis factor therapy in this scenario, our case provides an example of the successful use of infliximab for rituximab-induced colitis, which likely helped the patient avoid a colectomy.

  • Inflammatory bowel disease
  • Crohn's disease
  • Unwanted effects / adverse reactions
  • Drugs: gastrointestinal system
  • Immunology

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: the case was identified and managed clinically by MG, who also asked for the patient’s consent, performed the patient’s endoscopic procedures and is the guarantor of the paper. EJ analysed histologically the samples and provided the pathology pictures in both figures. LH and PMP were involved in the inpatient care of the patient and in writing the manuscript with the supervision of MG. LH and PMP contributed equally to this paper. All authors gave final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.