Journal of medical case reports · 2026
Do we need to treat dialysis patients differently? Infliximab therapy in a patient with ulcerative colitis on hemodialysis: a case report.
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Balogh Fruzsina, Angyal Dorottya, Gonczi Lorant, Lontai Livia, Lakatos Peter L, Ilias Akos
Аннотация
BACKGROUND: The prevalence of inflammatory bowel diseases is increasing among the elderly. Older patients with inflammatory bowel disease represent a vulnerable population whose treatment strategies are significantly impacted by comorbidities and frailty.
CASE PRESENTATION: We present the case of a 69-year-old, Hungarian, nonsmoker female patient with a history of elderly-onset inflammatory bowel disease. The patient has longstanding type 2 diabetes (on insulin since 2011) and is being treated for hypertension and hyperlipidemia. In 2011, a diagnosis of left-sided ulcerative colitis was made, presenting with symptoms of fever and bloody diarrhea. Following the ineffectiveness of several conservative treatment modalities, the patient initially underwent adalimumab therapy, exhibiting primary nonresponse. Subsequently, the treatment was switched to vedolizumab, but she later developed secondary loss of response. She was diagnosed with end-stage renal disease and was started on hemodialysis in January 2022. In May 2023, because of severe endoscopic and symptomatic disease activity (endoscopic Mayo score 3, partial Mayo score 6, C-reactive protein 26.0 mg/L, hemoglobin 111 g/L, albumin 39 g/L), infliximab therapy was initiated. We measured serial serum drug and anti-drug antibody concentrations to monitor the efficacy of the therapy and the effect of hemodialysis on drug concentrations. The patient responded to infliximab therapy, leading to clinical remission. Infliximab serum drug concentrations remained unaffected by hemodialysis.
CONCLUSION: This case clearly illustrates the impact of comorbidities and the importance of a multidisciplinary approach in the management of elderly patients with inflammatory bowel disease. We demonstrated that infliximab therapy is effective and safe in the presence of concomitant severe inflammatory bowel disease and end-stage renal disease requiring hemodialysis.
CASE PRESENTATION: We present the case of a 69-year-old, Hungarian, nonsmoker female patient with a history of elderly-onset inflammatory bowel disease. The patient has longstanding type 2 diabetes (on insulin since 2011) and is being treated for hypertension and hyperlipidemia. In 2011, a diagnosis of left-sided ulcerative colitis was made, presenting with symptoms of fever and bloody diarrhea. Following the ineffectiveness of several conservative treatment modalities, the patient initially underwent adalimumab therapy, exhibiting primary nonresponse. Subsequently, the treatment was switched to vedolizumab, but she later developed secondary loss of response. She was diagnosed with end-stage renal disease and was started on hemodialysis in January 2022. In May 2023, because of severe endoscopic and symptomatic disease activity (endoscopic Mayo score 3, partial Mayo score 6, C-reactive protein 26.0 mg/L, hemoglobin 111 g/L, albumin 39 g/L), infliximab therapy was initiated. We measured serial serum drug and anti-drug antibody concentrations to monitor the efficacy of the therapy and the effect of hemodialysis on drug concentrations. The patient responded to infliximab therapy, leading to clinical remission. Infliximab serum drug concentrations remained unaffected by hemodialysis.
CONCLUSION: This case clearly illustrates the impact of comorbidities and the importance of a multidisciplinary approach in the management of elderly patients with inflammatory bowel disease. We demonstrated that infliximab therapy is effective and safe in the presence of concomitant severe inflammatory bowel disease and end-stage renal disease requiring hemodialysis.