Abstract Background 21 year-old female with medical history of Vitiligo who was started on Rinvoq and within three weeks of starting developed new onset cough, shortness of breath, and oxygen requirement who was admitted to the Medical Intensive Care Unit (MICU) for acute hypoxic respiratory failure (AHRF). Case Presentation The patient was admitted to the MICU after being seen in the Emergency Department with cough, shortness of breath, and SpO2 saturation of 80% on room air. She was started on high-flow nasal cannula (HFNC) 60/60 with improvement to 95%. CT chest with contrast showed extensive multifocal ground-glass and consolidative opacities throughout the lungs. Patient was started on broad-spectrum antibiotics (Cefepime and Vancomycin) given immunosuppressed status. RSV / Flu / COVID PCR, Fungitell, and blood cultures were negative. Sputum culture was not obtained due to lack of sputum production. Given high suspicion for drug-induced pneumonitis she was started on high-dose Methylprednisolone and had rapid improvement. She was weaned to room air within 48 hours of steroid initiation. Management and Outcome This patient was managed as drug-induced pneumonitis secondary to Rinvoq. Rinvoq had been discontinued one week prior to presentation by the patient. She was prescribed a steroid taper and PJP / pneumonia prophylaxis with Bactrim and Doxycycline. Bronchoscopy was obtained prior to discharge with pathology showing acute inflammation and pneumonitis. Tissue cultures were negative for bacterial growth and viral testing was negative. The patient did well on the steroid taper and has a scheduled repeat CT scan two months from discharge to evaluate for long-term fibrosis or interstitial lung disease. She continues to follow with Pulmonology Discussion Rinvoq is a new Janus Kinase (JAK)-inhibiting medication that is commonly prescribed for auto-immune conditions. While pneumonitis is a known adverse effect of the medication class of JAK inhibitors, currently there are no reported cases of pneumonitis caused by Rinvoq, and it is not an reported observed adverse event in safety studies completed by Rinvoq manufacturers. This case report details an important adverse effect of Rinvoq previously not reported and adds to the growing literature of known pulmonary side effects of JAK-inhibitors. The case also provides evidence that Rinvoq should not be continued in the case of AHRF admissions to the MICU even with lack of a respiratory infection. This abstract is funded by: None
Hunting et al. (Fri,) studied this question.