Article Text

Rare disease
Pulmonary actinomycosis complicating infliximab therapy for Crohn disease
  1. Richard Cohen,
  2. William Bowie,
  3. Robert Enns,
  4. Julia Flint,
  5. Mark Fitzgerald
  1. Departments of Medicine and Pathology, University of British Columbia, Vancouver, Canada
  1. Richard Cohen, richardcohen{at}


The use of anti-tumour necrosis factor (TNF) agents has expanded significantly over the past few years, particularly for rheumatological diseases and Crohn disease. A number of associated opportunistic infections have been observed as a result of suppression of T-cell-mediated immunity, the most frequent being tuberculosis. This report describes a case of pulmonary actinomycosis in a 52-year-old patient receiving regular infusions of infliximab, an anti-TNF agent, for Crohn disease. He presented with a 12-day history of fever, night sweats and a non-productive cough on a background of a 9-year history of Crohn terminal ileitis. There was radiological evidence of a left upper lobe non-cavitatory pneumonia and bronchoscopic lavage fluid eventually grew Actinomyces graevenitzii. The patient was hospitalised and improved with antibiotic therapy. Within 4 weeks there was almost complete radiological resolution and infliximab was restarted after 4 months without further complication.

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  • Competing interests: none.

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