RESUMEN
BACKGROUND: Crohn Disease (CD) is an intestinal inflammatory condition characterized by a complex pathogenesis, with elevated levels of inflammatory cytokines. Adalimumab and certolizumab are two biologic drugs inhibiting TNF-α. OBJECTIVE: We report the first case of a probable relationship, according to Naranjo causality assessment score, between two consecutive treatments with TNF-α inhibitors and induced erectile dysfunction (ED), that disappeared after switching to another biologic drug (ustekinumab). CASE PRESENTATION: This case report describes a possible and important association of two TNF-α inhibitors (certolizumab and adalimumab) and ED in a male patient with CD, with resolution after switching to Ustekinumab (anti-interleukin 12 and 23 biologic drug). A 65 years old man experienced erectile dysfunction during treatment with an anti-TNF. The adverse effect disappeared after discontinuation of the drug. All necessary urologic exams were carried out. Adalimumab was replaced by certolizumab and sexual disfunction symptoms appeared again, improving typically at the end of treatment periods and getting worse with each new dose. RESULTS: Switching to ustekinumab lead to a resolution of the erectile dysfunction. CONCLUSION: We describe for the first time a sexual dysfunction possibly due to two similar anti TNF drugs and its resolution after the switch to another similar but different drug, highlighting the potential difference between biologic drugs.
Asunto(s)
Productos Biológicos , Enfermedad de Crohn , Disfunción Eréctil , Masculino , Humanos , Anciano , Adalimumab/efectos adversos , Enfermedad de Crohn/tratamiento farmacológico , Ustekinumab/efectos adversos , Inhibidores del Factor de Necrosis Tumoral/uso terapéutico , Factor de Necrosis Tumoral alfa , Disfunción Eréctil/inducido químicamente , Disfunción Eréctil/tratamiento farmacológico , Anticuerpos Monoclonales Humanizados/efectos adversos , Certolizumab Pegol/efectos adversos , Productos Biológicos/efectos adversos , Infliximab/efectos adversos , Resultado del TratamientoRESUMEN
We present the case of a 62-year-old man with Crohn's disease who consulted for abdominal pain and lower limbs edema. The patient developed Cushing's syndrome due to ectopic secretion of ACTH. Diagnostic imaging tests showed multiple metastatic liver lesions and asymmetric thickening of the ileum, that was suspected as the primary tumor. This tumor produced destabilizing gastrointestinal bleeding and an urgent surgical resection was performed. The histopathological study of the resection specimen confirmed a grade 3 neuroendocrine tumor.
Asunto(s)
Síndrome de ACTH Ectópico , Enfermedad de Crohn , Síndrome de Cushing , Tumores Neuroendocrinos , Masculino , Humanos , Persona de Mediana Edad , Síndrome de ACTH Ectópico/etiología , Síndrome de ACTH Ectópico/diagnóstico , Enfermedad de Crohn/complicaciones , Hormona Adrenocorticotrópica , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/patología , Tumores Neuroendocrinos/complicaciones , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/cirugíaRESUMEN
OBJECTIVE: to evaluate the role of Epstein-Barr virus (EBV) on the intestinal mucosa in the evolution of inflammatory bowel disease (IBD). The risk factors for EBV infection and the frequency of EBV-associated lymphoproliferative disorders in IBD patients were also investigated. METHODS: intestinal biopsies of IBD patients with available EBV status determined by Epstein-Barr-encoding RNA (EBER) in situ hybridization were identified in the Pathology Database of our center. Clinical information, including phenotypic characteristics of IBD, previous treatments, diagnosis of lymphoma and patient outcome were reviewed in all cases. RESULTS: fifty-six patients with IBD (28 Crohn's disease, 27 ulcerative colitis and one unclassified colitis) were included. EBV in intestinal mucosa was positive in 26 patients (46 %) and was associated to a lymphoproliferative syndrome in one case. EBV positivity was associated with severe histological activity (52 % vs 17.2 %; p 0.007), the presence of a lymphoplasmacytic infiltrate (50 % vs 33.3 %; p 0.03) and active steroid treatment (61.5 % vs 33.3 %; p 0.03). Multivariate analyses only found an association between EBV and lymphoplasmacytosis (p 0.001). Escalation in previous treatment was significantly more frequent in the EBER+ group (53.8 % vs 26.7 %; p 0.038). No cases developed lymphoma during follow-up. CONCLUSIONS: EBV on the intestinal mucosa is associated with a poor outcome of IBD and the need for escalation of therapy. Lymphoplasmacytic infiltrate is associated with EBV infection. EBER+ patients used steroids more frequently compared with EBER- patients. No EBER+ patients developed lymphoma during follow-up.
Asunto(s)
Colitis Ulcerosa , Enfermedad de Crohn , Infecciones por Virus de Epstein-Barr , Enfermedades Inflamatorias del Intestino , Colitis Ulcerosa/complicaciones , Enfermedad de Crohn/patología , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/diagnóstico , Herpesvirus Humano 4/genética , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/patologíaRESUMEN
OBJECTIVE: to investigate the prevalence of perianal disease, the associated phenotypical factors, its influence on prognosis and its impact on the use of health resources for patients with Crohn's disease. METHODS: a unicentric retrospective observational study was performed with 430 patients with Crohn's disease tracked through a monographical consultation of intestinal inflammatory disease. Demographic and phenotypical data of Crohn's disease, pharmacological and surgical treatments, complementary tests carried out and hospital admissions were analyzed. A comparative study between those patients without perianal disease and those with perianal disease was performed, both in simple form and complex form. RESULTS: the prevalence of perianal disease was 40.2 %, and fistulas and abscesses were the most frequent manifestations. These appearances were associated with an affected rectum and the existence of extra-intestinal manifestations. The patients with perianal disease most frequently required immuno-suppressant and biological treatment, but no further abdominal surgery. Amongst the patients with perianal disease, the need for biologics was more frequent for luminal disease (42.8 % vs 30.7 %). Furthermore, more explorations were needed, aimed at the study of perianal disease and recto-colonoscopies, although more magnetic resonance (MR)/computed tomography (CT) enterographies were not required. CONCLUSIONS: perianal disease has a high prevalence among patients with Crohn's disease, especially when the rectum is affected. It is associated with a worse prognosis and more frequently requires biological treatments due to perianal and luminal evolution, especially in cases of complex perianal disease. This condition calls for more hospital admissions and complementary tests.
Asunto(s)
Enfermedad de Crohn , Fístula Rectal , Absceso/complicaciones , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/epidemiología , Humanos , Pronóstico , Fístula Rectal/cirugía , Estudios RetrospectivosRESUMEN
Megacolon is a serious complication of inflammatory bowel disease that often requires a colectomy. Infliximab is a therapeutic alternative when conventional treatment fails, before resorting to surgery. Its use is currently based on the publication of isolated cases. We present a series of 12 patients with megacolon treated with infliximab, five with signs of systemic toxicity. Seventy-five percent of the patients avoided a colectomy during their acute episode after early infliximab treatment, 2.45 days after the megacolon diagnosis. There was a greater risk of surgery among patients with ulcerative colitis and toxicity criteria. Two more patients required follow-up surgery despite long-term infliximab treatment. No patient suffered significant treatment-related adverse effects or significant post-surgery complications.
Asunto(s)
Colitis Ulcerosa , Enfermedades Inflamatorias del Intestino , Megacolon , Colectomía , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/cirugía , Fármacos Gastrointestinales/uso terapéutico , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Infliximab/efectos adversos , Resultado del TratamientoRESUMEN
Mesalazine is a drug routinely used in ulcerative colitis and usually has few side effects. There have been reports of uncommon cases of severe mucocutaneous damage, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), induced by salicylates. It is important to diagnose these promptly due to the high morbidity and mortality rates. We describe the case of a 46-year-old female with ulcerative proctitis, who developed SJS following topical mesalazine use. The lesions responded well to intravenous corticosteroids after discontinuation of the drug.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Mesalamina/efectos adversos , Síndrome de Stevens-Johnson/etiología , Administración Tópica , Antiinflamatorios no Esteroideos/administración & dosificación , Femenino , Humanos , Mesalamina/administración & dosificación , Persona de Mediana EdadRESUMEN
BACKGROUND: The ideal length of treatment with thiopurines in patients with ulcerative colitis (UC) in sustained remission remains unknown. It is widely accepted that the drug withdrawal is associated with a worse outcome. The aim of this study was to analyze the outcome after this withdrawal and to identify predictors of relapse. METHODS: A multicenter and retrospective study was designed. A total of 102 patients with UC who discontinued thiopurines in a situation of sustained remission were included. All the patients were followed up until last revision or until relapse (understood as the occurrence of signs and symptoms of UC that required a rescue treatment). RESULTS: After thiopurines withdrawal, overall relapse was recorded in 32.35% of the patients: 18.88% in the first year, 36.48% in the third, and 43.04% in the fifth year after withdrawal. On multivariate analysis, predictors of relapse were the time from diagnosis of UC until the starting of thiopurines (hazard ratio [HR], 1.01; 95% confidence interval [CI], 1.01-1.02; P = 0.039), the number of relapses before the withdrawal (HR, 1.3; 95% CI, 1.01-1.66; P = 0.029), pancolitis (HR, 5.01; 95% CI, 1.95-26.43; P = 0.028), the duration of treatment with thiopurines (HR, 0.15; 95% CI, 0.03-0.66; P = 0.013) and the situation of biological remission at withdrawal (HR, 0.004; 95% CI, 0.0001-0.14; P = 0.002). CONCLUSIONS: The withdrawal of thiopurines in patients with UC, although in sustained remission, is related to a high relapse rate. Clinical variables such as the extent of the disease, the duration of treatment or time from diagnosis to the start of thiopurines should be considered before stopping these drugs.
Asunto(s)
Azatioprina/uso terapéutico , Colitis Ulcerosa/tratamiento farmacológico , Mercaptopurina/uso terapéutico , Adulto , Anciano , Colitis Ulcerosa/diagnóstico , Colonoscopía , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Pronóstico , Inducción de Remisión , Estudios Retrospectivos , Resultado del Tratamiento , Privación de TratamientoAsunto(s)
Amiloidosis/patología , Enfermedades Gastrointestinales/patología , Placa Amiloide/patología , Adulto , Anciano , Anciano de 80 o más Años , Amiloidosis/complicaciones , Endoscopía Gastrointestinal , Femenino , Enfermedades Gastrointestinales/etiología , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Bacteriemia/etiología , Colitis Ulcerosa/tratamiento farmacológico , Enfermedad de Crohn/tratamiento farmacológico , Inmunosupresores/efectos adversos , Listeriosis/etiología , Bacteriemia/microbiología , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/inmunología , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/inmunología , Susceptibilidad a Enfermedades , Humanos , Huésped Inmunocomprometido , Inmunosupresores/uso terapéutico , Mucosa Intestinal/microbiología , Mucosa Intestinal/patología , Masculino , Meningitis por Listeria/etiología , Adulto JovenAsunto(s)
Azatioprina/uso terapéutico , Inmunodeficiencia Variable Común/complicaciones , Enfermedad de Crohn/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Corticoesteroides/uso terapéutico , Azatioprina/efectos adversos , Infecciones por Campylobacter/complicaciones , Enfermedad de Crohn/complicaciones , Gastritis/complicaciones , Gastritis/tratamiento farmacológico , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: regenerative nodular hyperplasia (RNH) is a rare liver disease with an etiology that is not well understood. Among the etiological factors are purine-analogue drugs such asazathioprine. CASE REPORT: we present a case of a 47-year-old patient diagnosed with Crohn´s disease in treatment with azathioprine due to corticosteroid dependency who developed RNH with clinical and laboratory signs of portal hypertension one year after starting treatment. After discontinuation of azathioprine, the patient started treatment and, given the poor disease progression, started treatment with adalimumab. This was continued with an excellent response and without deleterious effects on the liver. DISCUSSION: the relevance of this case is twofold: First, this is a rare and early side effect of azathioprine treatment and this is an irreversible disease with potentially serious complications. Second, because treatment was carried out with biological drugs (adalimumab) despite the patient having advance liver disease with portal hypertension without any evidence of it worsening, nor signs of deleterious effects or complications, given that there is scarce or no experience with adalimumab treatment in this type of situation.
Asunto(s)
Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Hiperplasia Nodular Focal/tratamiento farmacológico , Adalimumab , Azatioprina/efectos adversos , Hiperplasia Nodular Focal/inducido químicamente , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Colitis Ulcerosa/complicaciones , Infecciones por Citomegalovirus/etiología , Citomegalovirus/patogenicidad , Complicaciones Posoperatorias , Reservoritis/etiología , Adulto , Colitis Ulcerosa/terapia , Colitis Ulcerosa/virología , Infecciones por Citomegalovirus/diagnóstico , Humanos , Masculino , Proctocolectomía Restauradora , PronósticoAsunto(s)
Bacteriemia/microbiología , Clostridium/aislamiento & purificación , Enterocolitis Seudomembranosa/microbiología , Anciano , Combinación Amoxicilina-Clavulanato de Potasio/efectos adversos , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Ciprofloxacina/efectos adversos , Clostridium/clasificación , Enterocolitis Seudomembranosa/tratamiento farmacológico , Femenino , Humanos , Inmunocompetencia , Metronidazol/uso terapéutico , Especificidad de la Especie , Úlcera/etiología , Úlcera/microbiologíaAsunto(s)
Inmunosupresores/efectos adversos , Enfermedades Inflamatorias del Intestino/etiología , Trasplante de Riñón/efectos adversos , Trasplante de Hígado/efectos adversos , Complicaciones Posoperatorias , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Adulto JovenAsunto(s)
Anemia Hemolítica Autoinmune/tratamiento farmacológico , Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Colitis Ulcerosa/tratamiento farmacológico , Adulto , Anemia Hemolítica Autoinmune/etiología , Colitis Ulcerosa/complicaciones , Femenino , Humanos , InfliximabRESUMEN
Visceral artery aneurysms are rare vascular lesions. Hepatic aneurysms are the second most common type of visceral aneurysm after those of the splenic artery. These aneurysms often have a nonspecific clinical presentation and are difficult to diagnose before rupture. Because the natural course of hepatic aneurysms leads to rupture, with a high rate of morbidity and mortality, their early diagnosis is essential for surgical correction. We report a case of obstructive jaundice caused by a 7-cm gastroduodenal artery aneurysm in which the diagnosis was suggested by abdominal computed tomography and magnetic resonance cholangiography and was confirmed by angiography. The patient was surgically treated. In the following 48 h he presented ischemic-based acute hepatic failure and underwent left hepatic lobe resection. The patient finally died from a pulmonary thromboembolism.