Asunto(s)
Angiodisplasia/tratamiento farmacológico , Inhibidores de la Angiogénesis/uso terapéutico , Hemorragia Gastrointestinal/tratamiento farmacológico , Talidomida/uso terapéutico , Angiodisplasia/complicaciones , Angiodisplasia/diagnóstico , Angiografía , Transfusión Sanguínea , Endoscopía Capsular , Niño , Colitis/tratamiento farmacológico , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Inmunosupresores/uso terapéutico , Intestino Delgado , Nutrición Parenteral Total , Recto , RecurrenciaRESUMEN
Fulminating acute ulcerative colitis (UC) is a potentially life threatening medical emergency. Up to 30% of individuals respond poorly to corticosteroids alone and second line medical or surgical therapies are indicated. We describe the successful use of chimeric anti-CD25 therapy in 4 such children poorly responsive to combined therapy with intravenous steroids and calcineurin inhibitors with a pretreatment predictive risk of colectomy of 85-100%. Clinical disease activity scores normalized within 72 hours of anti-CD25 administration and colonic histology provided evidence of mucosal healing within 10-14 days. None required emergency colectomy. Anti-CD25 is efficacious in fulminating UC and randomized placebo controlled trials appear indicated.