Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2020; 8(24): 6389-6395
Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6389
Refractory case of ulcerative colitis with idiopathic thrombocytopenic purpura successfully treated by Janus kinase inhibitor tofacitinib: A case report
Yoriaki Komeda, Toshiharu Sakurai, Kazuko Sakai, Yasuyoshi Morita, Arito Hashimoto, Tomoyuki Nagai, Satoru Hagiwara, Itaru Matsumura, Kazuto Nishio, Masatoshi Kudo
Yoriaki Komeda, Toshiharu Sakurai, Arito Hashimoto, Tomoyuki Nagai, Satoru Hagiwara, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
Kazuko Sakai, Kazuto Nishio, Department of Genome Biology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
Yasuyoshi Morita, Itaru Matsumura, Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
Author contributions: Komeda K and Sakurai T wrote the manuscript. Komeda K, Sakurai T, Morita Y and Hashimoto A was the patient’s doctor in charge and was responsible for collecting medical history. Komeda Y, Sakurai T, Sakai K, Nagai T, Hagiwara S, Matsumura I, Nishio K and Kudo M contributed data analysis and interpretation of data.
Supported by JSPS KAKENHI, No. 17K09396, No. 17H06404, and No. 20K08368.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images. The study was approved by the relevant institutional review boards (#28-224).
Conflict-of-interest statement: The authors declare no conflicts of interest.
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 which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Toshiharu Sakurai, MD, PhD, Assistant Professor, Senior Lecturer, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka 589-8511, Japan. sakurai@med.kindai.ac.jp
Received: July 27, 2020
Peer-review started: July 27, 2020
First decision: August 8, 2020
Revised: October 29, 2020
Accepted: November 4, 2020
Article in press: November 4, 2020
Published online: December 26, 2020
Processing time: 145 Days and 2.9 Hours
Abstract
BACKGROUND

Concomitant ulcerative colitis (UC) and idiopathic thrombocytopenic purpura (ITP) is a rare phenomenon. The management of UC with ITP can be challenging, since a decreased platelet count augments UC.

CASE SUMMARY

A 24-year-old man with UC and steroid-resistant ITP experienced UC flare. Although continuous infusion of cyclosporine was initiated, UC did not improve. The administration of tofacitinib subsequently led to the induction of remission. The patient has maintained remission of UC and ITP for over one year on tofacitinib treatment. Whole transcriptomic sequencing was performed for inflamed rectal mucosae obtained before and after the initiation of Janus kinase (JAK) inhibitor, suggesting that distinct molecular signatures seemed to be regulated by JAK inhibitors and other conventional therapies including tumor necrosis factor lockers.

CONCLUSION

Tofacitinib should be considered in refractory cases of UC with ITP.

Keywords: Ulcerative colitis; Idiopathic thrombocytopenic purpura; Tofacitinib; Whole transcriptome analysis; Case report; Predictive biomarker

Core Tip: We herein report a refractory case of ulcerative colitis associated with idiopathic thrombocytopenic purpura successfully treated with tofacitinib. The relationship between these two disease entities underscore treatment implications, given their potentially shared immunological pathway and responses to similar medications. To investigate changes in gene signatures during tofacitinib therapy, whole transcriptomic sequencing was performed for inflamed rectal mucosae obtained before and after the initiation of Janus kinase (JAK) inhibitor. Distinct molecular signatures seemed to be regulated by JAK inhibition and tumor necrosis factor blockade, suggesting that the identification of gene sets may be able to predict therapeutic responses to medications.