Henoch Schonlein purpura in pediatric patients with inflammatory bowel disease: A case series

2021 ◽  
Author(s):  
Anjani P. Sheth ◽  
Karina L. Vivar ◽  
Annette M. Wagner ◽  
Lacey L. Kruse
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Pediatric Patients ◽  
Case Series ◽  
Henoch Schonlein Purpura ◽  
Inflammatory Bowel ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

scholarly journals A153 RECURRENT HENOCH-SCHONLEIN PURPURA FOLLOWING TREATMENT WITH ADALIMUMAB

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 157-159
Author(s):  
L Stallard ◽  
P Church
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Lower Limb ◽  
First Episode ◽  
Henoch Schonlein Purpura ◽  
Inflammatory Bowel ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

Abstract Background Anti Tumour Necrosis Factor-α agents have revolutionised the management of inflammatory bowel disease. Cutaneous adverse events complicate therapy in up to 20% of cases. Most reactions are mild and do not warrant a change of therapy. Henoch–Schönlein purpura (HSP) has rarely been associated with anti-TNFα therapy. It is an acute vasculitis of small vessels that presents with cutaneous purpura of the lower limb, arthritis, nephritis and gastrointestinal involvement. Aims To describe the clinical course of a 16-year-old male presenting with recurrent HSP secondary to adalimumab for treatment of inflammatory bowel disease Methods A retrospective chart review of the patient’s electronic medical record. A literature review of the relevant medical literature. Results History 16 year old boy with Crohn’s disease, initial induction with exclusive enteral nutrition and maintained on adalimumab monotherapy since May 2017. Adalimumab initially 40 mg every 2 weeks, increased to every 10 days in September 2019 due to loose stool and mild inflammation throughout the colon on reassessment colonoscopy. Four separate incidences of purpuric rashes occurring 2–3 days after receiving adalimumab between November 2019 and July 2020. Purpura and petechiae of the lower limb with associated swelling of the feet and heel pain consistent with HSP. Purpura resolved within 1 to 3 weeks, treated with oral steroids on 1 occasion. First episode occurred following increase in dose frequency to every 10 days. Adalimumab frequency was further increased to every 7 days in March 2020. Following this he had 3 further HSP episodes. There was no history of preceding illness or other clear inciting event for HSP. Physical Exam Scattered petechiae on the lower limb bilaterally with large palpable purpura to his feet. Mild swelling to the right foot with tenderness to heel on palpation. Nil other joint swelling. No petechiae elsewhere. Investigations Urinalysis showed trace blood, no proteinuria. Mildly elevated CRP and ESR. Fecal calprotectin elevated >1800. Clinical Progress Rheumatology and Dermatology were consulted. Due to recurrent HSP and active luminal Crohn’s disease on repeat colonoscopy, adalimumab was discontinued and he started Ustekinumab September 2020. There has been no recurrence of relapsing rash and joint pains. Conclusions Four previous cases of HSP associated with Adalimumab have been described, three with Crohn’s disease and 1 with Ulcerative Colitis. Cutaneous manifestations occurred within 18 months of treatment in all previously reported cases. Our patient was treated with Adalimumab for 30 months prior to his first episode of HSP. This association with HSP is not unique to adalimumab, extending to other members of the anti TNFα class including infliximab and etanercept. Hypothesized mechanisms include antibody production, eosinophil activation, shifts in T cell responses and direct drug toxicity to vessel walls. Funding Agencies None

Lymphocytic Colitis With Increased Apoptosis: A Marker of Mutation in T-Cell-Mediated Immunity?

2020 ◽  
Vol 23 (6) ◽  
pp. 443-447
Author(s):  
Anas Bernieh ◽  
Melanie Hakar ◽  
Jerzy Stanek
Keyword(s):  
Inflammatory Bowel Disease ◽  
T Cell ◽  
Bowel Disease ◽  
Pediatric Patients ◽  
Case Series ◽  
Lymphocytic Colitis ◽  
Genetic Mutations ◽  
Cell Mediated Immunity ◽  
Inflammatory Bowel ◽  
Stat3 Mutation

Lymphocytic colitis is a subtype of microscopic colitis that is mostly seen in adults. It presents mainly as chronic nonbloody diarrhea, with the hallmark of normal or near-normal endoscopy. In this case series, we are presenting 4 pediatric patients with lymphocytic colitis with prominent apoptosis of the colonic gland epithelium. Remarkably, all the patients have genetic mutations known to be associated with autoimmune enteropathy. Three patients have a CTLA4 mutation, and 1 patient has an STAT3 mutation. These mutations were previously reported in association with inflammatory bowel disease, but a specific connection with lymphocytic colitis has not been described. This report investigates the histopathology of such lesions in children and adolescents.

scholarly journals Vedolizumab: An Emerging Treatment Option for Pediatric Inflammatory Bowel Disease

2021 ◽  
Vol 26 (8) ◽  
pp. 795-801
Author(s):  
Pooja Shah ◽  
Danielle McDonald
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Randomized Trials ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Case Series ◽  
Pediatric Inflammatory Bowel Disease ◽  
Dosing Regimens ◽  
Inflammatory Bowel

Vedolizumab is a humanized α4β7-integrin antagonist that is currently FDA-approved for adult inflammatory bowel disease. Limited evidence is available to guide use in pediatric patients, though off-label use is described in the form of retrospective reviews and case series. Collectively these publications begin to establish safety and efficacy data in pediatric patients < 18 years of age. Additionally, dosing regimens described in the literature serve to guide weight-based dosing, which is not established at this time. This narrative review aims to summarize the available literature and provide recommendations for vedolizumab use in the pediatric population. A literature search was performed in PubMed (January 2014–December 2020) using the keyword vedolizumab. Based on the available evidence, vedolizumab appears to be a safe and moderately effective agent for treatment of refractory pediatric inflammatory bowel disease. Prospective, randomized trials are warranted to optimize dosing regimens and to establish long-term safety.

Lymphoma in Pediatric-Onset Inflammatory Bowel Disease Treated with Infliximab Monotherapy: A Case Series

2021 ◽  
Author(s):  
Alejandro Llanos-Chea ◽  
Jason M. Shapiro ◽  
Rachel W. Winter ◽  
Logan Jerger ◽  
Timothy Menz ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Case Series ◽  
Inflammatory Bowel ◽  
Pediatric Onset

scholarly journals Vitamin C Deficiency in Inflammatory Bowel Disease: The Forgotten Micronutrient

2021 ◽  
Author(s):  
Katie A Dunleavy ◽  
Ryan C Ungaro ◽  
Laura Manning ◽  
Stephanie Gold ◽  
Joshua Novak ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Vitamin C ◽  
Bowel Disease ◽  
Fruits And Vegetables ◽  
Nutritional Assessment ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Vitamin C Deficiency ◽  
Inflammatory Bowel

Abstract Background Micronutrient deficiencies are common in patients with inflammatory bowel disease (IBD). To date, the literature has focused on vitamin D, vitamin B12, and iron deficiencies. Methods We report a case series of 20 patients with IBD and vitamin C deficiency treated at a single tertiary care center. Results Sixteen (80%) patients had symptoms of clinical scurvy, including arthralgia, dry brittle hair, pigmented rash, gingivitis, easy bruising and/or brittle nails. Eighteen patients underwent a nutritional assessment, 10 (56%) patients reported complete avoidance of fruits and vegetables, and 3 (17%) reported reduced intake of fruits and vegetables. Conclusions Vitamin C deficiency should be considered in IBD patients, particularly those with reduced fruit/vegetable intake, as it can lead to significant signs and symptoms.

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