Mycosis fungoides in a patient with ulcerative colitis on anti-tumor necrosis factor-alpha therapy
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CASE REPORT
Mycosis fungoides in a patient with ulcerative colitis on anti‑tumor necrosis factor‑alpha therapy Takeshi Yasuda1 · Tomohisa Takagi1,2 · Jun Asai3 · Norito Katoh3 · Junya Kuroda4 · Yasumichi Kuwahara5 · Yukiko Morinaga6 · Eiichi Konishi6 · Kazuhiko Uchiyama1 · Yuji Naito1 · Yoshito Itoh1 Received: 28 August 2020 / Accepted: 16 October 2020 © Japanese Society of Gastroenterology 2020
Abstract A 46-year-old man with a history of ulcerative colitis (UC) for over 25 years was treated with infliximab for 7 years. He noticed gradually spreading erythema on his right lower abdomen, femur, and buttocks. Skin biopsy from the right lower abdomen revealed massive invasion of lymphocytes in the papillary dermis and epidermal layer. In conjunction with the findings of immunohistochemistry, the skin lesion was diagnosed as mycosis fungoides (MF) at infiltration stage. Infliximab was discontinued, and narrow-band ultraviolet light B therapy was initiated to treat the skin lesion. The patient achieved remission for MF following treatment and UC has not relapsed for more than 1 year with 5-aminosalicylic acid treatment alone. This is the first case of MF in a UC patient treated with anti-tumor necrosis factor-alpha (anti-TNFα). Lymphoma occurrence is a complication of treatment with anti-TNFα agent or thiopurine. However, there is no evidence regarding the relationship between MF and UC. Hence, these immunomodulatory agents may have triggered the occurrence of MF in this case. When treating UC patients with immunomodulatory agents, the possibility of MF or other types of lymphoma as rare complications must be considered. Keywords Ulcerative colitis · Mycosis fungoides · Anti TNFα agent · Thiopurine
Introduction * Tomohisa Takagi [email protected]‑m.ac.jp 1
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi–Hirokoji, Kamigyo‑ku, Kyoto 602‑8566, Japan
2
Department for Medical Innovation and Translational Medical Science, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602‑8566, Japan
3
Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
4
Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
5
Department of Biochemistry and Molecular Biology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
6
Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
Inflammatory bowel diseases (IBD) are characterized by chronic gut inflammation of unknown etiology and sometimes cause various clinical symptoms in the outside of large intestine. In Asian countries, as well as America and Europe, the prevalence of IBD has been increasing recently [1]. Due to this tendency, the therapeutic agents of IBD have also been increasing, and many IBD
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