TY - JOUR
T1 - Idelalisib-induced colitis and skin eruption mimicking graft-versus-host disease
AU - Hammami, Muhammad Bader
AU - Al-Taee, Ahmad
AU - Meeks, Marshall
AU - Fesler, Mark
AU - Hurley, M. Yadira
AU - Cao, Dengfeng
AU - Lai, Jin Ping
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Introduction: Idelalisib is a selective inhibitor of the delta isoform of phosphatidylinositol 3-kinase which was approved by the United States Federal Drug Administration in 2014 for the treatment of relapsed chronic lymphocytic leukemia and indolent non-Hodgkin lymphoma. Drug-induced injury of the gastrointestinal tract is a relatively frequent but usually under-recognized disease entity. Case presentation: We report the case of a 56-year-old male with a history of relapsed follicular lymphoma status post allogenic bone marrow transplant who developed severe diarrhea with a skin eruption mimicking graft-versus-host disease (GVHD) 6 months after starting idelalisib. He underwent a colonoscopy demonstrating a grossly normal-appearing colon and terminal ileum. Biopsies taken during the procedure revealed mild active ileitis, colitis, and proctitis with frequent epithelial apoptosis, and focal intra-epithelial lymphocytosis. Skin biopsies revealed sub-acute spongiotic dermatitis suggestive of either contact dermatitis or an eczematous drug reaction. Symptoms were attributed to idelalisib given their resolution with withdrawal of the drug in conjunction with the skin and colonic biopsies. Conclusion: High clinical suspicion and awareness of the histological features of idelalisib-associated colitis is important to distinguish it from potential mimickers such as GVHD and infectious colitis.
AB - Introduction: Idelalisib is a selective inhibitor of the delta isoform of phosphatidylinositol 3-kinase which was approved by the United States Federal Drug Administration in 2014 for the treatment of relapsed chronic lymphocytic leukemia and indolent non-Hodgkin lymphoma. Drug-induced injury of the gastrointestinal tract is a relatively frequent but usually under-recognized disease entity. Case presentation: We report the case of a 56-year-old male with a history of relapsed follicular lymphoma status post allogenic bone marrow transplant who developed severe diarrhea with a skin eruption mimicking graft-versus-host disease (GVHD) 6 months after starting idelalisib. He underwent a colonoscopy demonstrating a grossly normal-appearing colon and terminal ileum. Biopsies taken during the procedure revealed mild active ileitis, colitis, and proctitis with frequent epithelial apoptosis, and focal intra-epithelial lymphocytosis. Skin biopsies revealed sub-acute spongiotic dermatitis suggestive of either contact dermatitis or an eczematous drug reaction. Symptoms were attributed to idelalisib given their resolution with withdrawal of the drug in conjunction with the skin and colonic biopsies. Conclusion: High clinical suspicion and awareness of the histological features of idelalisib-associated colitis is important to distinguish it from potential mimickers such as GVHD and infectious colitis.
KW - Drug-induced colitis
KW - Graft-versus-host disease
KW - Idelalisib
UR - http://www.scopus.com/inward/record.url?scp=85007173635&partnerID=8YFLogxK
U2 - 10.1007/s12328-016-0707-y
DO - 10.1007/s12328-016-0707-y
M3 - Article
C2 - 28025783
AN - SCOPUS:85007173635
SN - 1865-7257
VL - 10
SP - 142
EP - 146
JO - Clinical Journal of Gastroenterology
JF - Clinical Journal of Gastroenterology
IS - 2
ER -