Idelalisib-induced colitis and skin eruption mimicking graft-versus-host disease

Muhammad Bader Hammami, Ahmad Al-Taee, Marshall Meeks, Mark Fesler, M. Yadira Hurley, Dengfeng Cao, Jin Ping Lai

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)142-146
Number of pages5
JournalClinical Journal of Gastroenterology
Volume10
Issue number2
DOIs
StatePublished - Apr 1 2017

Keywords

  • Drug-induced colitis
  • Graft-versus-host disease
  • Idelalisib

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