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[Colonic perforation due to invasive amebic colitis during anti-TNF therapy for spondyloarthritis]

Juan Pablo Restrepo1, María del Pilar Molina2

  • 1Universidade do Quindío, Quindío, Colômbia.

Revista Brasileira De Reumatologia
|December 3, 2014
PubMed

Insights

Tumor necrosis factor (TNF) blockade, used for spondyloarthritis, may increase the risk of invasive amebiasis. A patient on anti-TNF therapy developed a life-threatening bowel perforation from Entamoeba histolytica.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Gastroenterology

Background:

  • Anti-tumor necrosis factor (TNF) therapy is effective for rheumatic conditions like spondyloarthritis.
  • Infections are known complications of anti-TNF agents, including bacterial, mycobacterial, viral, and fungal pathogens.
  • Entamoeba histolytica, a protozoan parasite, typically causes colitis and hepatic abscesses, with bowel perforation being a rare but fatal outcome.

Observation:

  • A 46-year-old woman with spondyloarthritis was treated with anti-TNF therapy.
  • The patient presented with colonic perforation.
  • The perforation was attributed to invasive amebic colitis.

Findings:

  • Tumor necrosis factor (TNF) plays a crucial role in cell-mediated immunity against Entamoeba histolytica.
  • TNF enhances macrophage activation and nitric oxide (NO) release to combat amebiasis.
  • Blocking TNF may impair the host's defense against E. histolytica, potentially increasing virulence.

Implications:

  • Anti-TNF therapy might increase the risk of severe amebic infections, including invasive colitis and perforation.
  • Physicians should consider amebiasis in patients on anti-TNF therapy presenting with gastrointestinal symptoms, especially in endemic areas.
  • Further research is needed to understand the complex interplay between TNF blockade and amebiasis to optimize patient management and safety.
Keywords:
Amebic ColitisAnti‐TNF InhibitorsColonic PerforationInibidores Anti‐TNF, Perfuração do colo, Colite amebiana

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