Toplicanin Aleksandar, Toncev Ljubisa, Matovic Zaric Vera, Sokic Milutinovic Aleksandra
Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Life (Basel). 2022 Nov 4;12(11):1784. doi: 10.3390/life12111784.
A wide spectrum of extraintestinal manifestations (EIMs) can burden patients with inflammatory bowel disease (IBD). EIMs contribute fairly to morbidity and mortality rates in IBD patients. Moreover, EIMs in IBD patients are so frequent that some suggest that IBD should be approached as a systemic disorder. Anemia is very common in IBD patients. The two most common types of anemia in IBD, iron deficiency anemia and anemia of chronic disease, are extraintestinal complications. Autoimmune hemolytic anemia (AIHA) is a rare extraintestinal manifestation of IBD, more frequent in ulcerative colitis (UC) than in Crohn's disease (CD). In this case-based review of the literature, we present a 36-year-old female patient diagnosed with Crohn's disease (CD) and Coombs positive AIHA, complicated by pulmonary thromboembolism and successfully treated with anti-tumor necrosis factor (anti-TNF) therapy. The underlying pathophysiological mechanism of AIHA in IBD is unclear. Treatment options for AIHA in IBD patients before biologic therapy included corticosteroids alone or in combination with azathioprine (AZA), methotrexate, and surgical treatment (colectomy and/or splenectomy). Currently, biologic therapy is a promising therapeutic option, especially in corticosteroid refractory or corticosteroid-dependent IBD patients with AIHA.
多种肠外表现（EIMs）会给炎症性肠病（IBD）患者带来负担。EIMs对IBD患者的发病率和死亡率有相当大的影响。此外，IBD患者中EIMs非常常见，以至于有人认为IBD应被视为一种全身性疾病。贫血在IBD患者中非常普遍。IBD中最常见的两种贫血类型，即缺铁性贫血和慢性病贫血，是肠外并发症。自身免疫性溶血性贫血（AIHA）是IBD一种罕见的肠外表现，在溃疡性结肠炎（UC）中比在克罗恩病（CD）中更常见。在本次基于病例的文献综述中，我们介绍了一名36岁的女性患者，她被诊断为克罗恩病（CD）和库姆斯试验阳性的AIHA，并伴有肺血栓栓塞症，经抗肿瘤坏死因子（抗TNF）治疗成功治愈。IBD中AIHA的潜在病理生理机制尚不清楚。在生物治疗之前，IBD患者AIHA的治疗选择包括单独使用皮质类固醇或与硫唑嘌呤（AZA）、甲氨蝶呤联合使用，以及手术治疗（结肠切除术和/或脾切除术）。目前，生物治疗是一种有前景的治疗选择，特别是对于患有AIHA的皮质类固醇难治性或皮质类固醇依赖性IBD患者。
