Department of Internal Medicine, Division of IBD, Japan Community Health Care Organization, Tokyo Yamate Medical Center, Tokyo, Japan.
Clin J Gastroenterol. 2020 Aug;13(4):560-563. doi: 10.1007/s12328-020-01108-5. Epub 2020 Mar 4.
We describe a case of refractory pouchitis successfully treated with tofacitinib. The patient was a 20-year-old woman diagnosed with ulcerative colitis at the age of 14 years. She underwent surgery at the age of 18 years for chronic active inflammation, despite an optimal medication regimen. Ten months after surgery, she was diagnosed with pouchitis. She did not respond to conventional conservative treatment; thus, the case was considered as that of refractory chronic pouchitis. Anti-tumor necrosis factor-α (TNF-α) therapy was administered, which led to some improvement; however, pouchitis recurred. Systemic steroid and vedolizumab were also administered, but the response was unsatisfactory. Therefore, surgery was considered; however, the patient refused to undergo surgery. As identical therapies are recommended for ulcerative colitis and pouchitis, they are considered to have a common etiology. Therefore, we considered tofacitinib therapy in this case. After obtaining the patient's informed consent, tofacitinib treatment was initiated. The therapy led to improvement in her symptoms as well as in the appearance of the pouch when observed on endoscopy, and surgery was avoided. Thus, tofacitinib may be considered a therapy option for refractory chronic pouchitis.
我们描述了一例使用托法替尼成功治疗难治性袋炎的病例。该患者为一名 20 岁女性，14 岁时被诊断为溃疡性结肠炎。尽管采用了最佳药物治疗方案，她仍于 18 岁时因慢性活动性炎症而接受了手术。手术后 10 个月，她被诊断为袋炎。她对常规保守治疗没有反应；因此，该病例被认为是难治性慢性袋炎。给予抗肿瘤坏死因子-α（TNF-α）治疗，症状有所改善；然而，袋炎再次发作。给予全身皮质类固醇和 vedolizumab 治疗，但反应不理想。因此，考虑手术；然而，患者拒绝手术。由于溃疡性结肠炎和袋炎的治疗方法相同，因此认为它们具有共同的病因。因此，我们考虑在本例中使用托法替尼治疗。在获得患者的知情同意后，开始使用托法替尼治疗。治疗后，患者症状改善，内镜下观察到袋炎外观也有所改善，避免了手术。因此，托法替尼可能是治疗难治性慢性袋炎的一种选择。
