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IS THERE A NEED FOR DENTAL CHECKUP PRIOR TO INFLIXIMAB INFUSION? A CASE REPORT AND REVIEW OF LITERATURE
T Misra, AA Mohamed, LA Dieleman
Centre of Excellence for Gastrointestinal Inflammation and Immunity Research, University of Alberta, Edmonton, Alberta
BACKGROUND: Infliximab (anti-TNF) is increasingly used in the treatment of Crohn’s disease with promising results in comparison to other medications used for the same disease. However, infection is the most common adverse effect of anti-TNF. The source of infection is often a hidden infection or a reactivation of a dormant infection.
CASE SUMMARY: Our case describes a 51-year-old female, smoker, with longstanding history of steroid-dependent Crohn’s disease with minimal luminal activity on methotrexate beside steroid. Infliximab was added for persistent perianal fistulae. After 4 weeks she presented to the emergency department with neurological symptoms. CT head revealed brain abscess. Cultures from this abscess grew Fusobacterium species, anaerobic organism mostly found in the oral cavity. The primary source was found to be a dental abscess secondary to poor dentition.
CONCLUSION: This case illustrates the need for clinicians to be vigilant in documenting dental problems in high risk patients prior to Infliximab therapy, especially in combination with other immunosuppressive therapy. Ruling out any infectious focus prior to the start of anti-TNF is advised and we encourage dental inspection particularly in high risk group such as smokers, elderly and patients with chronic illnesses. However, further observations and studies needed prior to generalizing this conclusion in all patients receiving anti-TNF.