Severe neutropenia following a single infliximab infusion in a child with Crohn disease
Bibliographic record
Abstract
Infliximab is highly efficacious in the treatment of pediatric and adult Crohn Disease.v,vi. Randomized-controlled trial data indicate that it has a role in the treatment of ulcerative colitis in adult patientsvii and it is currently being evaluated in pediatric ulcerative colitis patients in a prospective open label trialviii. Recognized adverse events associated with infliximab therapy include infusion reactions and skin eruptions, often psoriasiform in nature. Infectious complications include the reactivation of tuberculosis. Blood dyscrasias, seen in association with infliximab therapy, are uncommon. We report the development of profound neutropenia, subsequent to a single infliximab infusion for steroid-refractory ulcerative colitis, in an 8-year old boy. His neutrophil count prior to the infliximab (5mg/kg) therapy was 3.45 × 109/L. Although he had an excellent clinical response to the single infusion, he was found to have severe neutropenia (0.03 × 109/L) prior to the second, scheduled infusion, which was subsequently withheld. He was asymptomatic. Despite extensive investigations including a bone marrow examination, no other underlying cause was identified. We believe that the profound neutropenia developed as a consequence of infliximabinduced autoimmune destruction of neutrophils. A similar experience has been described in an adult Crohn disease patient who developed neutropenia (0.5 × 109/L) following the second infliximab infusion. This adult patient was found to be positive for granulocyte-bound-antibodies and neutrophil-specific-bound antibodies and developed similar episodes of neutropenia following subsequent infusions.ix It is our opinion that a similar mechanism was responsible for the neutropenia in our patient. To the best of our knowledge, this is the first report of profound neutropenia in a pediatric patient following an infliximab infusion. It highlights the need for ongoing hematological surveillance in all patients prior to infliximab therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".