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Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
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Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
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Chronic bowel diseases are a group of long-term conditions affecting the digestive tract, characterized by inflammation and damage to the gut lining. These conditions primarily include irritable bowel syndrome and inflammatory bowel disease.
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Introduction
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
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Crohn's disease
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Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
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Colitis associated with persistent drug-induced immune dysregulation.

Johanna Köhler1,2, Randolf Hammerl3, Daniel M Mayer4

  • 1Department of Clinical Pathology and Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden.

Virchows Archiv : an International Journal of Pathology
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Summary

Two patients developed chronic colitis years after lymphoma treatment due to persistent immune dysregulation, not a specific drug or infection. This suggests a new category: immune dysregulation-associated colitis (ID-colitis).

Keywords:
ColitisDrug inducedHistologyImmune dysfunctionImmune dysregulationStem cell transplantation

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Area of Science:

  • Gastroenterology
  • Oncology
  • Immunology

Background:

  • Adverse drug reactions commonly affect the gastrointestinal tract.
  • Chemotherapy and autologous stem cell transplantation are used for lymphoma treatment.

Observation:

  • Two cases of chronic colitis occurred months to years post-lymphoma therapy.
  • Patients exhibited altered immune status (decreased CD4/CD8 ratio, hypogammaglobulinemia) without prior inflammatory bowel disease or immunodeficiency.
  • Biopsies revealed chronic active colitis with architectural distortion, erosions, ulcers, and metaplasia.

Findings:

  • Colitis was linked to lymphoma therapy but not a specific agent.
  • Persistent immune dysregulation was identified as the likely driver of mucosal inflammation.
  • Histopathological findings included chronic active inflammation and metaplasia.

Implications:

  • Proposes "immune dysregulation-associated colitis" (ID-colitis) as a diagnostic term.
  • Highlights the role of persistent immune dysfunction in late-onset colitis post-chemotherapy.
  • Emphasizes the need to consider immune dysregulation in unexplained chronic colitis.