TY - JOUR
T1 - Case Report
T2 - Lymphoma Arising in an Ileal Pouch Anal Anastomosis After Immunomodulatory Therapy for Inflammatory Bowel Disease
AU - Schwartz, Lauren K.
AU - Kim, Michelle Kang
AU - Coleman, Morton
AU - Lichtiger, Simon
AU - Chadburn, Amy
AU - Scherl, Ellen
N1 - Funding Information:
Dr Scherl has received grant research support from Abbott, Centocor, Elan, Prometheus, and Salix; she has served as a Consultant and on the Advisory Board or Speaker’s Bureau for Abbott, AstraZeneca, Axcan, Centocor, Crohn’s & Colitis Foundation of America (CCFA), Proctor & Gamble, Prometheus Laboratories, Questcor Pharmaceuticals, Salix, Shire, Solvay, and TAP Pharmaceuticals; has received honorarium from Abbott, AstraZeneca, Axcan, Centocor, Proctor & Gamble, Prometheus Laboratories, Salix Pharmaceuticals, Solvay, and TAP Pharmaceuticals; and has received other financial or material support from Centocor-Research, Salix-Research, Abbott-Research, Prometheus-Research, and CCFA-Research.
PY - 2006/8
Y1 - 2006/8
N2 - The risk of lymphoma in inflammatory bowel disease (IBD) has raised concerns regarding the lymphogenic potential of immunomodulatory therapy. The link between immunosuppressive therapy and lymphoma risk is well established in patients with solid organ transplantations. In this population, it is postulated that lymphocytes infected with the Epstein-Barr virus (EBV) proliferate unchecked due to impaired cell-mediated immunity. A similar phenomenon may occur in IBD patients treated with multiple immunomodulators and biological agents. In this report, we describe a case of EBV-positive non-Hodgkin's lymphoma arising in the ileal pouch of a patient with ulcerative colitis. This patient was maintained on prednisone (>20 mg/day) for 8 months, cyclosporine for 7 months, and 6-mercaptopurine for nearly 2 years prior to a single infusion of infliximab (5 mg/kg). The cumulative effects of more than three agents, simultaneously and/or sequentially, may simulate posttransplantation immunosuppression and pose a significant threat of malignancy. Such patients may warrant more aggressive diagnostic surveillance and evaluation.
AB - The risk of lymphoma in inflammatory bowel disease (IBD) has raised concerns regarding the lymphogenic potential of immunomodulatory therapy. The link between immunosuppressive therapy and lymphoma risk is well established in patients with solid organ transplantations. In this population, it is postulated that lymphocytes infected with the Epstein-Barr virus (EBV) proliferate unchecked due to impaired cell-mediated immunity. A similar phenomenon may occur in IBD patients treated with multiple immunomodulators and biological agents. In this report, we describe a case of EBV-positive non-Hodgkin's lymphoma arising in the ileal pouch of a patient with ulcerative colitis. This patient was maintained on prednisone (>20 mg/day) for 8 months, cyclosporine for 7 months, and 6-mercaptopurine for nearly 2 years prior to a single infusion of infliximab (5 mg/kg). The cumulative effects of more than three agents, simultaneously and/or sequentially, may simulate posttransplantation immunosuppression and pose a significant threat of malignancy. Such patients may warrant more aggressive diagnostic surveillance and evaluation.
UR - http://www.scopus.com/inward/record.url?scp=33746342776&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2006.05.024
DO - 10.1016/j.cgh.2006.05.024
M3 - Article
C2 - 16854631
AN - SCOPUS:33746342776
SN - 1542-3565
VL - 4
SP - 1030
EP - 1034
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 8
ER -