Linear Mucosal Defect in Nintedanib-associated Colitis: A Rare Case with Collagenous Colitis-like Features.

Area of Science:

• Gastroenterology
• Pulmonology
• Pharmacology

Background:

• Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease.
• Nintedanib is a tyrosine kinase inhibitor used to treat IPF.
• Gastrointestinal side effects, such as diarrhea, are common with nintedanib.

Purpose of the Study:

• To report a case of drug-induced colitis with collagenous colitis-like features associated with nintedanib treatment.
• To highlight the novel finding of linear mucosal defects in nintedanib-associated colitis.

Main Methods:

• A 70-year-old male IPF patient on long-term nintedanib therapy presented with severe diarrhea.
• Colonoscopy revealed characteristic mucosal abnormalities.
• Histopathological examination of biopsies confirmed collagenous colitis-like changes.
• Nintedanib was withdrawn, and symptom resolution was monitored.

Main Results:

• The patient exhibited significant diarrhea, coarse mucosal appearance, erosion, and linear mucosal defects in the colon.
• Biopsies showed features consistent with collagenous colitis.
• Diarrheal symptoms completely resolved after nintedanib cessation.
• This represents the first reported instance of linear mucosal defects in nintedanib-induced colitis.

Conclusions:

• Nintedanib can induce drug-induced colitis presenting with collagenous colitis-like features and linear mucosal defects.
• The findings expand the known spectrum of nintedanib-associated gastrointestinal adverse events.
• Prompt recognition and nintedanib withdrawal are crucial for managing this condition.