Avalos Eduardo, Mohamed Ali, Shapiro Joel, Khalid Nida, Ocon Anthony
Internal Medicine, Rochester Regional Health, Rochester, USA.
Pathology, Rochester Regional Health, Rochester, USA.
Cureus. 2024 Dec 2;16(12):e74965. doi: 10.7759/cureus.74965. eCollection 2024 Dec.
Autoimmune enteritis (AIE) is a rare inflammatory condition with intractable diarrhea and malnutrition. Most cases are diagnosed during infancy, but rare adult-onset cases can occur. We present a male patient in his 60s with a history of psoriasis and psoriatic arthritis on etanercept who developed refractory and intractable diarrhea and malnutrition. Serologic and infectious work-up was negative. Despite holding etanercept and attempting treatments with antibiotics, diphenoxylate with atropine, loperamide, octreotide, and pancreatic enzymes, his symptoms persisted, ultimately necessitating total parenteral nutrition. Esophagogastroduodenoscopy showed duodenal bulb ulcerations and colonoscopy was normal. Biopsies showed intraepithelial neutrophils within the duodenal mucosa, active lymphocytic cryptitis, crypt abscesses, and villous atrophy and blunting without granulomas consistent with autoimmune enteritis. The patient was started on prednisone, budesonide, and adalimumab with improvement. After 4 months, he was maintained on adalimumab monotherapy, his bowel habits normalized, and he was able to tolerate a normal diet. This case illustrates a rare presentation of autoimmune enteritis in a patient with well-controlled psoriatic arthritis with etanercept.
自身免疫性肠炎（AIE）是一种罕见的炎症性疾病，伴有顽固性腹泻和营养不良。大多数病例在婴儿期被诊断出来，但也有罕见的成人发病病例。我们报告一名60多岁的男性患者，有银屑病和银屑病关节炎病史，正在使用依那西普治疗，他出现了难治性和顽固性腹泻及营养不良。血清学和感染性检查均为阴性。尽管停用了依那西普并尝试使用抗生素、复方地芬诺酯、洛哌丁胺、奥曲肽和胰酶进行治疗，他的症状仍持续存在，最终需要全胃肠外营养。食管胃十二指肠镜检查显示十二指肠球部溃疡，结肠镜检查正常。活检显示十二指肠黏膜内有上皮内中性粒细胞、活动性淋巴细胞隐窝炎、隐窝脓肿、绒毛萎缩和变钝，无肉芽肿，符合自身免疫性肠炎。患者开始使用泼尼松、布地奈德和阿达木单抗治疗后病情好转。4个月后，他维持阿达木单抗单药治疗，肠道习惯恢复正常，能够耐受正常饮食。该病例说明了在一名使用依那西普病情得到良好控制的银屑病关节炎患者中，自身免疫性肠炎的罕见表现。
