司库奇尤单抗诱发炎性肠病

Inflammatory bowel disease induced by secukinumab

1例34岁男性因银屑病自行使用司库奇尤单抗300 mg皮下注射、1次/周,共5次;随后300 mg皮下注射、1次/4周,共3次;之后出现脓血便。电子肠镜检查发现乙状结肠距肛门25 cm处弥漫性粘膜充血水肿,组织活检病理报告为乙状结肠重度慢性炎、糜烂及浅溃疡形成,考虑为司库奇尤单抗所致炎性肠病。立即停用该药,予美沙拉嗪灌肠液60 g、1次/d,半个月后脓血便明显改善,2个月后脓血便消失。复查电子肠镜发现乙状结肠距肛门20~25 cm处粘膜粗糙,呈颗粒状,有散在小片状出血,诊断为溃疡性结肠炎(缓解期)。停用美沙拉嗪灌肠液,改为美沙拉嗪栓0.5 g、1次/d。

A 34-year-old male patient received a subcutaneous injection of 300 mg of secukinumab once a week for 5 times,subsequently 300 mg once every 4 weeks for 3 times because of psoriasis.Then the patient developed bloody purulent stool.Electronic colonoscopy revealed diffuse mucosal congestion and edema in the sigmoid colon at a distance of 25 cm from the anus.The pathological examination results of tissue biopsy showed severe chronic inflammation,erosion,and shallow ulcer formationin the sigmoid colon.Inflammatory bowel disease caused by secukinumab was considered.Then the drug was stopped,and mesalazine enema solution 60 g once daily was given.After half a month of treatment,the patient′s bloody purulent stool was improved significantly,and after 2 months,it disappeared.Electronic colonoscopy showed that the mucosa of the sigmoid colon was rough,granular,and scattered with small patches of bleeding at a distance of 20 cm to 25 cm from the anus,which was diagnosed as having ulcerative colitis(in remission).Mesalazine enema was discontinued and changed to mesalazine suppository 0.5 g once daily.