Crohn’s Colitis Presenting With Node-Negative Colon Cancer and Liver Metastasis After Therapy With Infliximab: Report of Two Cases

I nfliximab (Remicade, Centocor Inc.) is a monoclonal antibody, cA2, targeted against tumor necrosis factor-alpha (TNF) approved for the treatment of Crohn’s disease and rheumatoid arthritis. The mechanism of infliximab is to specifically inhibit the activity of TNFthrough the neutralization of the proinflammatory cytokine. The drug is able to bind to the transmembrane receptor and thus inhibit the inflammatory effects of TNF. Furthermore, the cells that have infliximab bound to the cellular receptors can be lysed in vitro by complement. By decreasing the levels of TNF, there is a decrease in the inflammatory response and immune reaction. By decreasing the levels of TNFin patients with Crohn’s disease, signs and symptoms of the disease, including fistulas, have significantly improved. Infliximab is FDA approved for both induction and maintenance of remission of Crohn’s disease. Reported adverse reactions to infliximab include respiratory tract infections, including cough, sinusitis, pharyngitis, and bronchitis, nervous system effects, including headache, dizziness, and pain, musculoskeletal effects, including arthralgias and back pain, abdominal pain, including nausea and diarrhea, and chills and fever. Hypersensitivity reactions consisting of dyspnea, urticaria, and hypotension occur in approximately 10 percent of patients. Another complication of infliximab treatment is the reactivation of latent tuberculosis. By decreasing the immune response, tuberculosis can become symptomatic. A potential side effect of an immune modifying medication is the possibility of initiating a malignancy. The most commonly reported malignancy is lymphoproliferative disorder. In a report evaluating infliximab, nine patients reportedly developed a lymphoproliferative disorder, eight of which were lymphomas. It is unclear whether infliximab contributes to malignancy or whether the patient’s disease condition itself leads to the malignancy. A few studies have indicated a possible association between infliximab therapy for Crohn’s disease and the onset of lymphoma. However, a review of the literature did not produce any studies or case reports of infliximab treatment for Crohn’s disease associated with adenocarcinoma of the colon and colonic metastasis. We Correspondence to: Guy R. Orangio, M.D., Georgia Colon and Rectal Surgical Clinics, 5555 Peachtree Dunwoody Road, Suite 206, Atlanta, Georgia 30342, e-mail: gorangio@gcrsa.com Dis Colon Rectum 2005; 48: 1651–1655 DOI: 10.1007/s10350-005-0065-1 © The American Society of Colon and Rectal Surgeons Published online: 13 May 2005