mRNA-1273/rituximab

Abstract

A 49-year-old man developed pancolitis following treatment with rituximab for follicular lymphoma and COVID-19 vaccination with mRNA-1273 [routes and dosages not stated].The man presented with 6 weeks of watery, non-bloody diarrhoea, right upper quadrant pain, more than 10 pound weight loss and fever. He had been receiving maintenance therapy with rituximab for stage IVa follicular lymphoma, which was in remission. His medical history was remarkable for splenectomy. Two days prior to the onset of diarrhoea, he was vaccinated with mRNA-1273 [manufacture by Moderna] against SARS CoV-2 infection. A CT scan showed diffuse colonic wall thickening with new interval adjacent pancolonic fat stranding. Initial colonoscopy demonstrated diffuse scattered clean based ulcers between 1-8mm in size throughout the colon and terminal ileum. Biopsies revealed active chronic ileitis with eosinophils, occasional crypt abscess. The crypt abscess was negative for herpes simplex virus and cytomegalovirus or signs of recurrent lymphoma. Based on the findings, he was diagnosed with pancolitis secondary to immunosuppressive therapy of rituximab. Additionally, vaccination with mRNA-1273 was identified to be contributed in the development of pancolitis [not all durations of treatments to reaction onset stated].The man was then treated with budesonide, dicycloverine [Bentyl] and loperamide. Following 6 weeks of treatment, a repeat colonoscopy demonstrated circumferential hyperaemia/oedema with apthous ulcers throughout the colon. Therefore, unspecified corticosteroid therapy for induction and vedolizumab for maintenance of remission was planned [outcome not stated].