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Case Reports
. 2019 Apr 22:2019:2091089.
doi: 10.1155/2019/2091089. eCollection 2019.

α 4 β 7 Integrin Antagonist Vedolizumab for the Treatment of Refractory Ileitis

Rafał Filip  1 , Błażej Goliat  1 , Małgorzata Dziechciaż  2 , Piotr Dąbrowski  3 , Michał Osuchowski  4 , Piotr Paluszkiewicz  5
Affiliations
Case Reports

α 4 β 7 Integrin Antagonist Vedolizumab for the Treatment of Refractory Ileitis

Rafał Filip et al. Case Rep Gastrointest Med. .

Abstract

Background and aims: Ulcerative colitis (UC) is a superficial diffuse inflammation restricted to the colon and rectum. Inflammation within the small bowel may occur several years after a pancolectomy. The pathogenesis is unknown and seems to be different from Crohn's disease or other causes of diseases of the small intestine, but an association with colectomy due to UC is very likely.

Methods and results: We describe the case of a patient with a probable diagnosis of pan-UC accompanied by Sjögren's syndrome and partial IgA deficiency, who developed enteritis after a restorative pancolectomy. For induction and maintenance of remission, the patient was successfully treated with mycofenolate mofetil (MMF) and vedolizumab (VDZ).

Conclusions: We suggest that a previously refractory to standard therapy UC-related enteritis can be treated with combination MMF and VDZ.

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Figures

Figure 1
Figure 1
Representative endoscopy images: (a). Initial ileoscopy showing erythematous, edematous friable mucosa with the presence of spontaneous bleeding. (b). Follow-up ileoscopy demonstrating normal looking mucosa after 5 months of vedolizumab therapy.
Figure 2
Figure 2
Representative histology sections of the ileum. The biopsy specimen before the treatment (a) reveals villous architectural distortion and a combination of acute and chronic abundant inflammation of the lamina propria. The inflammation consists of neutrophils, plasma cells, and lymphocytes. After 5 months of vedolizumab therapy (b), stromal oedema, and hyperaemia only a few lymphocytes and plasma cells in the lamina propria are visible.
Figure 3
Figure 3
Representative endoscopy image of rectum and ileorectal anastomosis with swelling changes, congestion, and numerous aft-like loss of mucous membrane.
See this image and copyright information in PMC

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