Cancer Res Treat.  2020 Oct;52(4):1291-1295. 10.4143/crt.2020.406.

Crohn’s Disease Following Rituximab Treatment for Follicular Lymphoma in a Patient with Synchronous Gastric Signet Ring Cells Carcinoma: A Case Report and Literature Review

• Cavalcanti E
• Armentano R
• Lolli I

• KMID: 2507955
• DOI: http://doi.org/10.4143/crt.2020.406

Abstract

Recently, there have been a few reports of rituximab (RTX)-induced Crohn’s disease, but there is no literature available on successful long-term treatment and the clinical outcome of this condition. We retrospectively analyzed the clinical data of a rare case of Crohn’s disease induced by RTX administered as induction and prolonged maintenance therapy of a follicular lymphoma, diagnosed synchronously with a gastric signet ring cells carcinoma, treated at our hospital.

Keyword

Rituximab; Crohn’s disease; Lymphoma; Gastric signet ring cells carcinoma

Figure

• 

  Fig. 1. Positron emission tomography scan showing massive 18F-fluorodeoxyglucose uptake (maximum standardized uptake value, 7) and mesenteric lymph nodes enlargement.

• 

  Fig. 2. (A) Active-chronic inflammation with ulceration, crypt abscess formation and goblet cell depletion (H&E staining, ×5), (B) After rituximab therapy, CD20 cells staining was negative. (C) Immunohistochemistry with an anti-CD3 antibody demonstrated numerous intraepithelial mucosal T cells after therapy. (D) High tonaca propria and intraepithelial infiltration of macrophages (CD68+) (B-D, ×10).

Reference

References

1. Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn’s disease. Lancet. 2017; 389:1741–55.

2. Edwards JC, Cambridge G. Sustained improvement in rheumatoid arthritis following a protocol designed to deplete B lymphocytes. Rheumatology (Oxford). 2001; 40:205–11.

3. Pierpont TM, Limper CB, Richards KL. Past, present, and future of rituximab: the world’s first oncology monoclonal antibody therapy. Front Oncol. 2018; 8:163.

4. Barreiro Alonso E, Alvarez Alvarez A, Tojo Gonzalez R, de la Coba Ortiz C. Rituximab-associated colitis. Gastroenterol Hepatol. 2019; 42:251–2.

5. Mallepally N, Abu-Sbeih H, Ahmed O, Chen E, Shafi MA, Neelapu SS, et al. Clinical features of rituximab-associated gastrointestinal toxicities. Am J Clin Oncol. 2019; 42:539–45.

6. Varma P, Falconer J, Aga A, Prince HM, Pianko S. Rituximab-induced Crohn’s disease. Scand J Gastroenterol. 2017; 52:606–8.

7. Morita K, Shibano T, Maekawa K, Hattori M, Hida N, Nakamura S, et al. Crohn’s disease following rituximab treatment in a patient with refractory nephrotic syndrome. CEN Case Rep. 2019; 8:55–60.

8. Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016; 127:2375–90.

9. Machlowska J, Puculek M, Sitarz M, Terlecki P, Maciejewski R, Sitarz R. State of the art for gastric signet ring cell carcinoma: from classification, prognosis, and genomic characteristics to specified treatments. Cancer Manag Res. 2019; 11:2151–61.

10. Dada R. Diagnosis and management of follicular lymphoma: a comprehensive review. Eur J Haematol. 2019; 103:152–63.

11. Buske C, Hutchings M, Ladetto M, Goede V, Mey U, Soubeyran P, et al. ESMO Consensus Conference on malignant lymphoma: general perspectives and recommendations for the clinical management of the elderly patient with malignant lymphoma. Ann Oncol. 2018; 29:544–62.

12. Mauri C, Menon M. Human regulatory B cells in health and disease: therapeutic potential. J Clin Invest. 2017; 127:772–9.

13. Eckmann JD, Chedid V, Quinn KP, Bonthu N, Nehra V, Raffals LE. De novo colitis associated with rituximab in 21 patients at a tertiary center. Clin Gastroenterol Hepatol. 2020; 18:252–3.

14. Goetz M, Atreya R, Ghalibafian M, Galle PR, Neurath MF. Exacerbation of ulcerative colitis after rituximab salvage therapy. Inflamm Bowel Dis. 2007; 13:1365–8.

15. Xu XR, Liu CQ, Feng BS, Liu ZJ. Dysregulation of mucosal immune response in pathogenesis of inflammatory bowel disease. World J Gastroenterol. 2014; 20:3255–64.