Scheid Johannes F, Misdraji Joseph, Nath Barbara J, Yarze Joseph C
Division of Gastroenterology, Massachusetts General Hospital, Boston, MA.
Department of Pathology, Massachusetts General Hospital, Boston, MA.
ACG Case Rep J. 2021 Jan 13;8(1):e00520. doi: 10.14309/crj.0000000000000520. eCollection 2021 Jan.
Autoimmune enteropathy (AIE) is a rare autoimmune disorder that has been described both in pediatric and adult patients and usually causes intractable watery diarrhea. The management of AIE is not standardized because the disease shows variable response to different immunosuppressive regimens including corticosteroids, azathioprine, cyclophosphamide, 6-mercaptopurine, tacrolimus, cyclosporine-A, infliximab, vedolizumab, and abatacept. We present a patient with adult-onset AIE and intractable high-volume diarrhea resulting in numerous hospitalizations and temporary parenteral nutrition, who is now successfully maintained on ustekinumab. Therefore, ustekinumab should be considered for further evaluation as a therapeutic option in cases of refractory AIE.
自身免疫性肠病(AIE)是一种罕见的自身免疫性疾病,在儿科和成年患者中均有报道,通常会导致顽固性水样腹泻。AIE的治疗尚无标准化方案,因为该疾病对不同的免疫抑制方案(包括皮质类固醇、硫唑嘌呤、环磷酰胺、6-巯基嘌呤、他克莫司、环孢素A、英夫利昔单抗、维多珠单抗和阿巴西普)表现出不同的反应。我们报告了一例成年发病的AIE患者,其患有顽固性大量腹泻,导致多次住院及短期肠外营养,目前使用乌司奴单抗成功维持治疗。因此,对于难治性AIE病例,应考虑将乌司奴单抗作为一种治疗选择进行进一步评估。