Table 5

Toxicity while on infliximab requiring hospitalisation

Patient	Age	Gender	Toxicity	Management	Outcome	Concomitant immunosuppression
1	16	F	Macular rash, varicella	Treated with varicella immunoglobulin and acyclovir which settled over 48 h hospital admission	Stopped IFX due to adverse event	AZA
2	16	F	Labial abscess	Requiring drainage in theatre	Stopped IFX due to planned drug withdrawal	MTX
3	11	M	Perianal sepsis	Taken to theatre for incision and drainage	Stopped IFX due to planned drug withdrawal	AZA, CS
3	11	M	Night sweats and fatigue	Required admission for assessment; no treatment needed†	Stopped IFX due to planned drug withdrawal	AZA, CS
4	11	M	Gastroenteritis	Thought to be viral but required parenteral nutrition and admission to hospital for 21 days	Stopped IFX due to loss of response	Nil
5	14	M	Septic arthritis	Required 5-day admission with intravenous gentamicin and flucloxacillin	Continues on IFX	MTX, CS
6	13	M	Shingles	Rash spread for 2 weeks then stopped, treated with acyclovir, but required 48 h hospital admission	IFX continues	AZA, CS
7	8	M	Rectal stricture	Required admission for dilatation	Stopped IFX due to rectal stricture	CS, AZA
8	14	M	Rectal stricture	Required admission for dilatation	Continues of IFX	CS, MTX
9	17	M	Impaired memory, headache	Admitted for assessment; MRI normal then transitioned to adult services	Stopped IFX due to long drug holiday	CS, AZA
10	15	M	Lupus-like reaction	Prolonged stay in intensive care‡	Stopped IFX due to adverse event	AZA

†Patient had two separate toxicity episodes.
‡Patient had his 4th dose of IFX then developed pyrexia, deranged liver function tests and coagulopathy in conjunction with raised inflammatory markers and immunoglubulins requiring, in total, a 36-day hospitalisation, including intensive care admission. The patient was initially treated with broad spectrum antibiotics, but his pyrexia continued and serositis developed, so he was commenced on intravenous hydrocortisone (before changing to oral prednisolone) which resulted in a rapid improvement in symptoms, and the working diagnosis of lupus-like syndrome was made.
AZA, azathioprine; CS, corticosteroids; IFX, infliximab; MTX, methotrexate.