Life-threatening vasculo-Behçet following discontinuation of infliximab after three years of complete remission

Clin Exp Rheumatol. 2013 May-Jun;31(3 Suppl 77):96-8. Epub 2013 Jun 5.

Abstract

Behçet's disease (BD) is a chronic, complex multisystem vasculitis of unknown cause characterised for its ability to involve blood vessels of all sizes on both the arterial and venous sides of the circulation. It has been suggested that TNF-alpha plays a main role in the pathogenesis of BD. This hypothesis is supported by the efficacy of TNF-blocking antibodies in these patients, which have been shown to be very powerful in the induction of remission and as maintenance treatment on different BD manifestations, including severe vascular involvement. However, little is known about when and how to stop IFX after long-standing complete remission of these patients to avoid relapses. We describe a case of BD without previous vascular involvement that developed myocardial infarction and severe venous thromboses only four months after discontinuation of infliximab (IFX) after more than three years of complete remission. The patient did not respond to corticosteroids and intravenous cyclophosphamide and only recovered completely after reintroducing IFX.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies, Monoclonal / administration & dosage*
  • Behcet Syndrome / complications
  • Behcet Syndrome / diagnosis
  • Behcet Syndrome / drug therapy*
  • Behcet Syndrome / immunology
  • Electrocardiography
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Infliximab
  • Male
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / etiology*
  • Recurrence
  • Remission Induction
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Tumor Necrosis Factor-alpha / metabolism
  • Venous Thrombosis / diagnosis
  • Venous Thrombosis / drug therapy
  • Venous Thrombosis / etiology*

Substances

  • Antibodies, Monoclonal
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Infliximab