Anti-tumour necrosis factor-α therapy for severe enteropathy in patients with common variable immunodeficiency (CVID)

We present three common variable immunodeficiency (CVID) patients with<br />severe inflammatory bowel disease of unknown aetiology, resistant to steroid<br />treatment, treated with infliximab.After exclusion of any infection, infliximab<br />was given at a dose of 5 mg/kg every 4 weeks for a 3 month induction followed<br />by every 4–8 weeks depending on clinical response. Two of these patients had<br />predominantly small bowel disease; they both showed clinical response to<br />infliximab with weight gain and improvement of quality of life scores. The<br />third patient had large bowel involvement with profuse watery diarrhea; this<br />patient improved dramatically within 48 hours of having infliximab <br />treatment. All three patients have been maintained on infliximab treatment<br />for between 5 and 53 months (mean 37 months) with no evidence of increased<br />susceptibility to infections in the patients with small bowel disease, although<br />the third patient developed two urinary tract infections and a herpes zoster<br />infection following therapy. This is the first small case series to show that<br />infliximab is a useful addition to current therapy in this rare group of patients<br />with potentially life threatening enteritis.<br />