Severe cardiomyopathy induced by Adalimumab administration for Crohn's disease

The use of tumor necrosis factor alpha inhibitors - anti-TNFa (infliximab, adalimumab, and certolizumab) in the treatment of Inflammatory Bowel Disease (IBD) provide a major therapeutic advance, allowing significant benefits in the induction and maintenance of remission in Crohn’s disease [1-3]. However, the safety-profile of TNF inhibitors with regard to worsening or new onset of heart failure is still very controversial. Consequently, there has been a lot of attention paid to the risk of cardiovascular side effects associated with adalimumab therapy [4-6]. A 42 year old woman treated with adalimumab for severe Crohn’s disease exacerbation; 8 days after the second dose of adalimumab (80mg), she presented with dramatic clinical features of heart failure and pulmonary edema. Echocardiography demonstrated severely depressed left ventricle contractility with ejection fraction 35%; cardiac MRI revealed no gadolinium enhancement (no ischemia, no myocarditis). Adalimumab was discontinued, and patient was treated with evidence-based oral disease-modifying HF therapy; 2 months later, cardiac function has returned to normal. This case clearly demonstrated the acute onset of decompensated heart failure with adalimumab usage.