Paradoxical Inflammatory Bowel Disease Induced by Golimumab in a Patient With Ankylosing Spondylitis: A Case Report and Systematic Review

Abstract

Paradoxical reactions (PRs) to biologic medications, such as psoriasis, arthritis, and inflammatory bowel disease (IBD), have been increasingly recognized. The aim of reporting this case is to establish an association between golimumab and exacerbation or new (de novo) IBD in patients with axial spondyloarthritis (SpA).

Our case involves a young patient with juvenile-onset ankylosing spondylitis (AS) who developed de novo IBD following golimumab therapy for active spinal disease. The patient had no prior gastrointestinal (GI) symptoms, and AS symptoms significantly improved with golimumab. However, before the third dose, he experienced non-bloody diarrhea, mild abdominal cramping, and constitutional symptoms (fever, chills, and weight loss). Colonoscopy and biopsy confirmed unclassified IBD. The discontinuation of golimumab resulted in marked improvement in GI symptoms, but the recurrence of AS symptoms necessitated the initiation of infliximab, which resolved both AS and IBD symptoms.

A comprehensive systematic literature review was conducted (from 2008 to October 2024) on Medical Literature Analysis and Retrieval System Online (MEDLINE) Complete/PubMed and Scopus databases using both Medical Subject Heading (MeSH) terms and keywords related to golimumab, SpA, and paradoxical IBD. Data from included cases were extracted by two researchers, and the quality assessment of case reports was performed using a standardized tool. Four cases of paradoxical IBD development following golimumab treatment in patients with pre-existing IBD were identified.

This is the first reported case of de novo IBD development in a biologic-naïve patient with AS treated with golimumab. This case highlights the importance of prompt evaluation of gastrointestinal symptoms and early gastroenterology referral during biologic therapy.