Boon or Bane? Anti-Tumor Necrosis Factor Therapy Complicated by <i>Listeria monocytogenes</i> Meningitis Culminating in Colectomy for Ulcerative Colitis
Bibliographic record
Abstract
Anti-tumor necrosis factor (TNF) biologics have revolutionized the management of inflammatory bowel diseases (IBDs) by promoting mucosal healing and delaying surgical intervention in ulcerative colitis (UC). However, biologics can potentiate the risk of opportunistic infections alongside the use of other immunomodulators in IBD. As recommended by the European Crohn’s and Colitis Organisation (ECCO), anti-TNF-alpha therapy should be suspended in the setting of a potentially life-threatening infection. The objective of this case report was to highlight how the practice of appropriately discontinuing immunosuppression can exacerbate underlying colitis. We need to maintain a high index of suspicion for complications of anti-TNF therapy, so that we can intervene early and prevent potential adverse sequelae. In this report, a 62-year-old female presented to the emergency department with non-specific symptoms including fever, diarrhea and confusion on a background of known UC. She had been commenced on infliximab (INFLECTRA (R) ) 4 weeks earlier. Inflammatory markers were elevated, and Listeria monocytogenes was identified on both blood cultures and cerebrospinal fluid (CSF) polymerase chain reaction (PCR). The patient improved clinically and completed a 21-day course of amoxicillin advised by microbiology. After a multidisciplinary discussion, the team planned to switch her from infliximab to vedolizumab (ENTYVIO (R) ). Unfortunately, the patient re-presented to hospital with acute severe UC. Left-sided colonoscopy demonstrated modified Mayo endoscopic score 3 colitis. She has had recurrent hospital admissions over the past 2 years for acute flares of UC, ultimately culminating in colectomy. To our knowledge, our case-based review is unique in unpacking the dilemma of holding immunosuppression at the risk of IBD worsening. J Med Cases. 2023;14(5):155-161 doi: https://doi.org/10.14740/jmc4041
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".