Highlights
- •The prevalence of autoimmune diseases is higher in MS patients than in general population.
- •The present study is a report of a patient with aggressive MS which, then, developed to autoimmune hepatitis (AIH).
- •Therefore, she received rituximab for the treatment of both MS and AIH.
- •One week after the third cycle of rituximab, she developed ulcerative colitis.
- •It seems that taking some drugs may have an important role in the exacerbation of some autoimmune diseases.
Abstract
Multiple sclerosis (MS) is one of the most important demyelinating diseases that affects
the central nervous system. Its treatment often involves a long-term disease modifying
therapy. According to some studies, the prevalence of autoimmune disorders, such as
autoimmune hepatitis (AIH) and ulcerative colitis (UC) is higher in MS patients than
in the normal population. There are also few studies that have reported the onset
of UC after rituximab therapy.
The present study presents a report of a 31-years old female patient suffering from
aggressive multiple sclerosis, which developed into autoimmune hepatitis during the
MS therapy. Thereafter, she received rituximab for the treating both MS and AIH.
One week after the third cycle of rituximab (6 doses of 1000 mg), she experienced
abdominal pain, fever, and severe bloody diarrhea; finally, she was diagnosed with
ulcerative colitis (UC).
It seems that the administration of certain immunomodulators or immunosuppressive
drugs may have a main role in the exacerbation of some autoimmune diseases.
Keywords
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References
- Rituximab for refractory autoimmune hepatitis: a case report.Arab J. Gastroenterol. 2013; 14: 135-138
- Emerging roles of lymphatics in inflammatory bowel disease.Ann. N.Y. Acad. Sci. 2010; 1207: E75-E85
- Natalizumab-induced hepatic injury: a case report and review of literature.Mult. Scler. Relat. Disord. 2015; 4: 495-498
- Severe ulcerative colitis after rituximab therapy.Pediatrics. 2010; 126: e243-e246
- Association of demyelinating and inflammatory bowel diseases: a case series and overview of the literature.Noro Psikiyatr Ars. 2015; 52: 315-318
- A case of autoimmune hepatitis treated with rituximab.Case Rep. Gastroenterol. 2010; 4: 502-509
- Rituximab-associated colitis.Inflamm. Bowel Dis. 2013; 19: E41-E43
- Rituximab-induced immunodysregulatory ileocolitis in a patient with follicular lymphoma.J. Clin. Oncol. 2011; 29: e110-e112
- Rituximab for the treatment of patients with autoimmune hepatitis who are refractory or intolerant to standard therapy.Can. J. Gastroenterol. 2013; 27: 273-280
- Current and prospective pharmacotherapy for autoimmune hepatitis.Expert Opin. Pharmacother. 2014; 15: 1715-1736
- Successful treatment of refractory autoimmune hepatitis with rituximab.Pediatrics. 2013; 132: e526-e530
- Autoimmune hepatitis and interferon beta-1a for multiple sclerosis.Am. J. Gastroenterol. 2002; 97: 767-768
- Ulcerative colitis following B lymphocyte depletion with rituximab in a patient with Graves' disease.Gut. 2008; 57: 714-715
- Inflammatory bowel disease: clinical aspects and treatments.J. Inflamm. Res. 2014; 7: 113-120
Fernandez-Blanco I, Cara C, Perez M. De novo fulminant colitis after rituximab therapy on a non-Hodgkin lymphoma. Presented at United European Gastroenterology Week 2008 October 18-22, 2008; Vienna, Austria.
- A case of multiple sclerosis with atypical onset associated with autoimmune hepatitis and silent coeliac disease.Neurol. Sci. 2008; 29: 29-31
- Exacerbation of ulcerative colitis after rituximab salvage therapy.Inflamm. Bowel Dis. 2007; 13: 1365-1368
- Increased risk for demyelinating diseases in patients with inflammatory bowel disease.Gastroenterology. 2005; 129: 819-826
- B cell follicle-like structures in multiple sclerosis-with focus on the role of B cell activating factor.J. Neuroimmunol. 2014; 273: 1-7
- B-cell depletion with rituximab in relapsing-remitting multiple sclerosis.N. Engl. J. Med. 2008; 358: 676-688
- CNS demyelination with TNF-alpha blockers.Curr. Neurol. Neurosci. Rep. 2017; 17: 36
- Concurrence of inflammatory bowel disease and multiple sclerosis.Mayo Clin. Proc. 2000; 75: 802-806
- Multiple sclerosis and inflammatory bowel diseases: a systematic review and meta-analysis.J. Neurol. 2017; 264: 254-259
- Randomised placebo-controlled trial of rituximab (anti-CD20) in active ulcerative colitis.Gut. 2011; 60: 1520-1526
- Autoimmune hepatitis: a comprehensive review.J. Autoimmun. 2013; 41: 126-139
- New insights into an autoimmune mechanism, pharmacological treatment and relationship between multiple sclerosis and inflammatory bowel disease.Autoimmun. Rev. 2014; 13: 114-116
- Fulminant colitis Following rituximab therapy.Gastroenterol. Hepatol. (N.Y). 2016; 12: 58-60
- Severe acute autoimmune hepatitis after natalizumab treatment.Dig. Liver Dis. 2012; 44: 356-357
- The treatment of autoimmune hepatitis.Curr. Clin. Pharmacol. 2012; 7: 318-327
- A systematic review of the incidence and prevalence of autoimmune disease in multiple sclerosis.Mult. Scler. 2015; 21: 282-293
- Natalizumab-induced autoimmune hepatitis in a patient with multiple sclerosis.Mult. Scler. 2013; 19: 1234-1235
- Autoimmune hepatitis-like reaction developing in a patient treated with interferon-beta1a.Histopathology. 2015; 66: 605-607
- Chronic intestinal inflammatory condition generates IL-10-producing regulatory B cell subset characterized by CD1d upregulation.Immunity. 2002; 16: 219-230
- Inflammatory bowel disease: an increased risk factor for neurologic complications.World J. Gastroenterol. 2014; 20: 1228-1237
- Glatiramer acetate induced acute exacerbation of autoimmune hepatitis in a patient with multiple sclerosis.J. Neurol. 2007; 254: 816-817
- Association between ulcerative colitis and multiple sclerosis.Intern Med. J. 2007; 37: 721-724
- Unmasking of autoimmune hepatitis in a patient with MS following interferon beta therapy.Neurology. 2006; 66: 1954-1955
- The late adverse events of rituximab therapy--rare but there!.Leuk. Lymphoma. 2009; 50: 1083-1095
- Case series: ulcerative colitis, multiple sclerosis, and interferon-beta 1a.Inflamm. Bowel Dis. 2010; 16: 2001-2003
- Rituximab in multiple sclerosis: a retrospective observational study on safety and efficacy.Neurology. 2016; 87: 2074-2081
- Successful treatment of autoimmune hepatitis and idiopathic thrombocytopenic purpura with the monoclonal antibody, rituximab: case report and review of literature.Liver Int. 2006; 26: 625-629
- Development of ulcerative colitis in a patient with multiple sclerosis following treatment with interferon beta 1a.World J. Gastroenterol. 2007; 13: 3638-3640
- Ulcerative colitis: exceptional consequence after rituximab therapy.Ann. Pharm. Fr. 2011; 69: 265-269
- Autoimmune hepatitis and multiple sclerosis: a coincidental association?.Mult. Scler. 2005; 11: 691-693
- Development of autoimmune hepatitis type 1 after pulsed methylprednisolone therapy for multiple sclerosis: a case report.World J. Gastroenterol. 2008; 14: 5474-5477
- Rapid onset of ulcerative colitis after treatment with interferon beta1a in a patient with multiple sclerosis.J. Crohns Colitis. 2011; 5: 75-76
- Interferon beta 1a-induced severe autoimmune hepatitis in patients with multiple sclerosis: report of two cases and review of the literature.Ann. Hepatol. 2015; 14: 273-280
- Rituximab: mechanism of action.Semin Hematol. 2010; 47: 115-123
- Platelet abnormalities during colonic inflammation.Inflamm. Bowel Dis. 2013; 19: 1245-1253
- Inflammatory bowel disease: a paradigm for the link between coagulation and inflammation.Inflamm. Bowel Dis. 2009; 15: 1245-1255
- Inflammatory bowel disease: pathogenesis.World J. Gastroenterol. 2014; 20: 91-99
Article info
Publication history
Published online: March 01, 2018
Accepted:
February 27,
2018
Received in revised form:
February 19,
2018
Received:
November 18,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
