A Small Blemish: Isotretinoin-Induced Microscopic Colitis.

Microscopic colitis is a form of colonic inflammation that presents with chronic nonbloody diarrhea that can only be diagnosed histologically with biopsies obtained during colonoscopy. We report a rare case of isotretinoin-induced microscopic colitis in a patient who was prescribed this medication for nodular acne with a 1-year history of nonbloody diarrhea, bloating, cramping, and foul-smelling gas. Cessation of this medication in addition to initiating treatment with budesonide resulted in remission of the patient's symptoms. The presence of chronic diarrhea in patients who are taking isotretinoin should raise suspicion for this condition and warrant further investigation.

Treatment-resistant severe capecitabine-induced diarrhoea resolved with oral budesonide.

Chemotherapy-induced diarrhoea (CID) is a risk of antineoplastic regimens, often associated with 5-fluorouracil (5-FU), irinotecan and capecitabine. Current treatment guidelines for CID include the use of loperamide and octreotide but do not account for other therapies, including budesonide. Small case reports have shown benefit with budesonide in CID secondary to 5-FU and irinotecan, but there is no literature base addressing budesonide use in CID secondary to capecitabine. We describe a case of a patient with severe capecitabine-induced diarrhoea that was refractory to guideline based therapy but resolved with the use of budesonide.

Infliximab-Induced Aseptic Meningitis in a Patient with Crohn's Disease.

Infliximab is an anti-tumor necrosis factor α (TNFα) monoclonal antibody that treats moderate-to-severe Crohn's disease. In rare cases, infliximab has been associated with drug-induced aseptic meningitis. We present a 46-year-old woman with migraines and inflammatory Crohn's colitis treated with intravenous infliximab and methotrexate. She developed nuchal rigidity, photophobia, and headache 2 days after each of her infliximab infusions, with symptom resolution 1 week post-infusion. Her exam, imaging, and cerebrospinal fluid analysis were consistent with drug-induced aseptic meningitis. She discontinued infliximab and started vedolizumab with continued remission of her Crohn's disease.

Novel use of rituximab in macrophage activation syndrome secondary to systemic lupus erythematosus.

Macrophage activation syndrome (MAS) is a rare disease characterised by aberrant immune hyperactivation of T lymphocytes and macrophages driven by cytokine dysfunction. The HLH-2004 protocol is commonly used for the treatment of MAS, but significant toxicities are associated. We describe a case of MAS secondary to systemic lupus erythematosus in a young female that responded well to rituximab in lieu of etoposide. She continues to be in remission 1 year following the completion of rituximab infusion and is maintained on hydroxychloroquine. This case highlights the need for further research on the use of rituximab and other available biologics in the setting of MAS in order to help guide further alternative treatment decisions.