Fukushima Tsuneo, Nakajima Kouichi, Nozawa Hiroshi, Nishino Haruo, Sugita Akira, Koganei Kazutaka, Futatsuki Ryou, Yamaguchi Shigeki, Asano Shiori, Matsushima Makoto
Matsushima Clinic.
Department of IBD, Yokohama Municipal Citizen's Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2019;116(4):324-329. doi: 10.11405/nisshoshi.116.324.
We herein report a case involving a 23-year-old male patient with active Crohn's disease complicated by Guillain-Barrè syndrome during ustekinumab therapy. At age 11, the patient developed an anal fistula and was found to have multiple aphthae on the rectosigmoid colon, for which he was diagnosed with Crohn's disease. At age 12, he underwent gastrojejunal anastomosis for pyrolic stenosis. At age 20, a longitudinal ulcer was found on the ascending colon, and at age 21, aphthae were found on the stomach and efferent jejunum. At age 22, adalimumab was started, but the patient noted abdominal pain and diarrhea 4 months later. Hence, adalimumab was switched to ustekinumab (2017 June). Though ustekinumab was effective, the patient noted anorexia, weakness, and bilateral lower extremity numbness 1 year later (2018 June) and was admitted to the hospital. He was then diagnosed with Guillain-Barrè syndrome after spinal tap, neurological, and hematological examinations. Immunoglobulin therapy was provided but was less effective. The patient has since been receiving physical therapy. This has been the first report regarding Guillain-Barrè syndrome as a complication during ustekinumab therapy.
我们在此报告一例病例,该病例为一名23岁男性患者,患有活动性克罗恩病,在接受乌司奴单抗治疗期间并发吉兰-巴雷综合征。患者11岁时出现肛瘘,直肠乙状结肠发现多处阿弗他溃疡,因此被诊断为克罗恩病。12岁时,因幽门狭窄接受胃空肠吻合术。20岁时,升结肠发现纵行溃疡,21岁时,胃和空肠输出袢发现阿弗他溃疡。22岁时开始使用阿达木单抗,但4个月后患者出现腹痛和腹泻。因此,将阿达木单抗换为乌司奴单抗(2017年6月)。尽管乌司奴单抗有效,但1年后(2018年6月)患者出现厌食、乏力和双下肢麻木,并入院治疗。经腰椎穿刺、神经学和血液学检查后,他被诊断为吉兰-巴雷综合征。给予了免疫球蛋白治疗,但效果不佳。此后患者一直在接受物理治疗。这是关于乌司奴单抗治疗期间并发吉兰-巴雷综合征的首例报告。