Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2023; 29(32): 4912-4919
Published online Aug 28, 2023. doi: 10.3748/wjg.v29.i32.4912
Drug-induced entero-colitis due to interleukin-17 inhibitor use; capsule endoscopic findings and pathological characteristics: A case report
Keita Saito, Kiichiro Yoza, Shinichiro Takeda, Yoshihiro Shimoyama, Ken Takeuchi
Keita Saito, Kiichiro Yoza, Shinichiro Takeda, Yoshihiro Shimoyama, Ken Takeuchi, Department of Gastroenterology, Tsujinaka Hospital Kashiwano-Ha, Kashiwa 277-0871, Japan
Author contributions: Saito K wrote the first draft of the manuscript; Yoza K and Takeda S were mainly responsible for the endoscopic procedures; Shimoyama Y and Takeuchi K were primarily responsible for the patients’ inpatient care.
Informed consent statement: Informed written consent was obtained from the patient and her parents for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Keita Saito, MD, Doctor, Department of Gastroenterology, Tsujinaka Hospital Kashiwano-Ha, No. 178-2 Wakashiba, Kashiwa 277-0871, Japan. keisaitou.ymgt@gmail.com
Received: May 15, 2023
Peer-review started: May 15, 2023
First decision: July 10, 2023
Revised: July 18, 2023
Accepted: August 1, 2023
Article in press: August 1, 2023
Published online: August 28, 2023
Processing time: 101 Days and 22.5 Hours
Abstract
BACKGROUND

Interleukin-17 (IL-17) inhibitors are known to cause exacerbation or new onset of inflammatory bowel disease upon administration. However, few reports have described characteristic endoscopic and histopathologic findings, and no small intestinal lesions have been reported so far.

CASE SUMMARY

A woman in her 60s with psoriasis was administered ixekizumab (IXE), an anti-IL-17A antibody, for the treatment of psoriasis. Twenty months after commencing treatment, the patient visited our hospital because of persistent diarrhea. Blood tests performed at the time of the visit revealed severe inflammation, and colonoscopy revealed multiple round ulcers throughout the colon. A tissue biopsy of the ulcer revealed infiltration of inflammatory cells and granuloma-like findings in the submucosal layer. Capsule endoscopy revealed multiple jejunal erosions. After the withdrawal of IXE, the symptoms gradually improved, and ulcer reduction and scarring of the colon were endoscopically confirmed.

CONCLUSION

To the best of our knowledge, 17 reports have documented IL-17 inhibitor-induced entero-colitis with endoscopic images, endoscopic findings, and pathological characteristics, including the present case. Nine of these cases showed diffuse loss of vascular pattern, coarse mucosa/ulcer formation in the left colon, and endoscopic findings similar to those of ulcerative colitis. In the remaining eight cases, discontinuous erosions and ulcerations from the terminal ileum to the rectum were seen, with endoscopic findings similar to those of Crohn’s disease. In this case, the findings were confirmed by capsule endoscopy, which has not been previously reported.

Keywords: Interleukin-17 inhibitor; Ixekizumab; Drug-induced entero-colitis; Capsule endoscopy; Case report

Core Tip: While Interleukin-17 (IL-17) inhibitors are effectively used in the treatment of psoriasis, psoriatic arthritis, and ankylosing spondylitis, they are ineffective in patients with Crohn’s disease (CD) and can worsen their condition. To the best of our knowledge, we present capsule endoscopic images of IL-17 inhibitor-induced entero-colitis for the first time, suggesting that IL-17-induced inflammatory lesions may be distributed in the proximal small bowel, unlike CD lesions. We also compared the endoscopic and pathological features of IL-17 inhibitor-induced entero-colitis with those previously reported.