Successful transition to mirikizumab following hepatic abscess during adalimumab therapy in a patient with ulcerative colitis.
Kazuya Miyaguchi, Hisashi Matsumoto, Rie Shiomi et al.
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Case in brief
A 19-year-old woman with pancolitis-type ulcerative colitis developed persistent fever, worsening diarrhea, hematochezia, and right upper quadrant pain while receiving maintenance adalimumab. Contrast-enhanced CT showed active colitis and a hepatic abscess. Adalimumab was stopped, and she received intravenous ceftriaxone and metronidazole. Once infection control and abscess regression were confirmed, mirikizumab was started for active colitis. Her symptoms improved rapidly, and she achieved sustained clinical and endoscopic remission without abscess recurrence during long-term follow-up.
What made this case unusual
The case describes transition to mirikizumab after a hepatic abscess developed during anti-TNF therapy, with sustained remission and no reported abscess recurrence.
Diagnostic / clinical pearl
In this case, CT identified a hepatic abscess complicating active ulcerative colitis during adalimumab therapy. Mirikizumab was initiated only after infection control and abscess regression were confirmed.
Why it matters
The optimal biologic after deep infection during anti-TNF therapy remains unclear; this case supports further study of second-line options after infection control.