Gastrointestinal pathologic findings of teriflunomide associated diarrhea

Abstract

Background: Diarrhea is generally a benign and self-limited adverse effect of teriflunomide. Small intestinal pathology has yet to be described with teriflunomide associated diarrhea.

Objective: To report small intestinal pathology in teriflunomide associated diarrhea.

Methods: Small intestinal and colonic biopsies were obtained from a patient with teriflunomide associated diarrhea.

Results: Small intestinal biopsy demonstrated blunting of villi, increased intraepithelial lymphocytes and expansion of lamina propria. Gliadin and t-transglutaminase antibodies were negative. Diarrhea resolved following elimination of teriflunomide with cholestyramine.

Conclusion: This is the first reported case of small intestinal inflammation similar to celiac disease in teriflunomide associated diarrhea.

Keywords: Celiac disease; Diarrhea; Disease modifying therapies; Gastroenteritis; Multiple Sclerosis; Teriflunomide.