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Clinical Journal of Gastroenterology

, Volume 10, Issue 2, pp 142–146 | Cite as

Idelalisib-induced colitis and skin eruption mimicking graft-versus-host disease

  • Muhammad Bader HammamiEmail author
  • Ahmad Al-Taee
  • Marshall Meeks
  • Mark Fesler
  • M Yadira Hurley
  • Dengfeng Cao
  • Jin-Ping Lai
Case Report

Abstract

Introduction

Idelalisib is a selective inhibitor of the delta isoform of phosphatidylinositol 3-kinase which was approved by the United States Federal Drug Administration in 2014 for the treatment of relapsed chronic lymphocytic leukemia and indolent non-Hodgkin lymphoma. Drug-induced injury of the gastrointestinal tract is a relatively frequent but usually under-recognized disease entity.

Case presentation

We report the case of a 56-year-old male with a history of relapsed follicular lymphoma status post allogenic bone marrow transplant who developed severe diarrhea with a skin eruption mimicking graft-versus-host disease (GVHD) 6 months after starting idelalisib. He underwent a colonoscopy demonstrating a grossly normal-appearing colon and terminal ileum. Biopsies taken during the procedure revealed mild active ileitis, colitis, and proctitis with frequent epithelial apoptosis, and focal intra-epithelial lymphocytosis. Skin biopsies revealed sub-acute spongiotic dermatitis suggestive of either contact dermatitis or an eczematous drug reaction. Symptoms were attributed to idelalisib given their resolution with withdrawal of the drug in conjunction with the skin and colonic biopsies.

Conclusion

High clinical suspicion and awareness of the histological features of idelalisib-associated colitis is important to distinguish it from potential mimickers such as GVHD and infectious colitis.

Keywords

Drug-induced colitis Idelalisib Graft-versus-host disease 

Notes

Acknowledgements

None.

Compliance with ethical standards

Conflict of interest:

The authors declare that they have no conflict of interest.

Human Rights:

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent:

Informed consent was obtained from all patients for being included in the study.

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Copyright information

© Japanese Society of Gastroenterology 2016

Authors and Affiliations

  • Muhammad Bader Hammami
    • 1
    Email author
  • Ahmad Al-Taee
    • 2
  • Marshall Meeks
    • 3
  • Mark Fesler
    • 4
  • M Yadira Hurley
    • 5
  • Dengfeng Cao
    • 6
  • Jin-Ping Lai
    • 7
  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineSaint Louis University School of MedicineSt LouisUSA
  2. 2.Department of Internal MedicineSaint Louis University School of MedicineSt. LouisUSA
  3. 3.Saint Louis University School of MedicineSt. LouisUSA
  4. 4.Division of Hematology and OncologySaint Louis University School of MedicineSt. LouisUSA
  5. 5.Department of DermatologySaint Louis University School of MedicineSt. LouisUSA
  6. 6.Department of Pathology and ImmunologyWashington University School of MedicineSt LouisUSA
  7. 7.Department of PathologySaint Louis University School of MedicineSt. LouisUSA

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