Rituximab-induced Ileocolitis in a Patient with Gastric MALToma: A Case Report and Literature Review

Abstract

Rituximab (RTX) is effective for treating cancer, but reports of RTX-associated enterocolitis are limited. We herein report the case of a 65-year-old man who developed RTX-induced ileocolitis. He was diagnosed with gastric mucosa-associated lymphoid tissue lymphoma (MALToma) and treated with RTX. He complained of bloody diarrhea after RTX. Mucosal inflammation on colonoscopy indicated RTX-induced ileocolitis. He was treated with corticosteroids, and his symptoms improved. We reviewed the RTX-associated gastrointestinal adverse events and classified the features into ulcerative colitis, Crohn's disease, microscopic colitis, and ileocolitis. To our knowledge, this is the first case of a Japanese patient who developed RTXinduced ileocolitis.

Cytokine Release Syndrome–Associated Colitis: Insights From a Case of Rituximab-Induced Pancolitis

“…Among these, 13 patients developed RTX-induced UC, 3,14–16 11 had RTX-induced Crohn's disease, 15,17–19 9 had RTX-induced MC, and 2 had ileocolitis. 7,20 A case report also suggested a link between colitis and Toro virus infection after RTX treatment, although our patient's stool polymerase chain reaction (PCR) panel was negative. Given our patient's rapid improvement within 24 hours, the colonoscopy was deferred.…”

Infliximab rescue therapy in a case of severe granulomatous colitis associated with rituximab use

“…We have presented a case of severe rituximab-induced colitis that achieved full remission with infliximab rescue therapy. While many cases of rituximab-induced colitis have been published, previous papers have generally reported the use of mesalazine12–15 and corticosteroids 5 13 15–17. Generally, severe cases have resulted in colectomy 5–7.…”

Impact of Anti-CD20 therapies on the immune homeostasis of gastrointestinal mucosa and their relationship with de novo intestinal bowel disease in multiple sclerosis: a review

“…Anti-CD20 monoclonal antibodies can cause GI side effects with IBD-like symptoms and epithelial lesions in MS and non-MS patients. Evidence of this association comes from case reports suggesting that RTX and OCR treatment may not only cause IBD exacerbation, but also direct GI toxicity in the form of de novo UC and CD ( Shahmohammadi et al, 2018 ; Lee et al, 2020 ; Barnes et al, 2021 ; Au et al, 2022 ; Sunjaya et al, 2020 ; Klug et al, 2022 ; el Fassi et al, 2008 ; Tsuzuki et al, 2021 ; Cavalcanti et al, 2020 ; Shankar et al, 2019 ; Barreiro Alonso et al, 2019 ; Morita et al, 2019 ; Uzzan et al, 2018 ; Varma et al, 2017 ; Fraser et al, 2016 ; Lipka et al, 2016 ; Bhalme et al, 2013 ; Sekkach et al, 2011 ; el Fassi et al, 2011 ; Vallet et al, 2011 ; Ardelean et al, 2010 ; Goetz et al, 2007 ; Blombery et al, 2011 ). However, in the reported cases many other environmental factors could be involved in the development of GI adverse effects, such as the simultaneous use of drugs or the presence of concomitant pathologies that could contribute to local tissue damage ( D’Haens, 2007 ).…”

“…In 83% of the cases reported by Mallepally et al, RTX was not discontinued, and colitis was controlled symptomatically with non-biological agents. The management of the acute phase of colitis typically consisted of fluid therapy, intravenous hydrocortisone with subsequent change to oral prednisone in a decreasing regimen, and oral mesalazine (5-ASA) ( Tsuzuki et al, 2021 ). Corticosteroid enemas were added in case of rectal or distal sigmoid colon involvement.…”