Cyclophosphamide-associated enteritis: A rare association with severe enteritis

Severe Enteritis after Cyclophosphamide Administration in a Patient with Microscopic Polyangiitis: A Case Report and Literature Review

Severe enteritis is a rare side effect of cyclophosphamide (CPA) therapy, and only two cases have been reported to date. We herein report a 60-year-old man who developed severe enteritis after intravenous CPA administration for microscopic polyangiitis. He was successfully treated by discontinuation of CPA administration and long-term intensive supportive care. A diagnosis of CPA-associated enteritis was made based on the clinical course and imaging and pathological findings. This review of three cases of CPA-related enteritis, including our case, suggests that prompt CPA discontinuation and intensive systemic management are necessary when patients have gastrointestinal symptoms after CPA administration.

Cyclophosphamide-associated enteritis presenting with severe protein-losing enteropathy in granulomatosis with polyangiitis: A case report

BACKGROUND

Although cyclophosphamide (CPA) is the key drug for the treatment of autoimmune diseases including vasculitides, it has some well-known adverse effects, such as myelosuppression, hemorrhagic cystitis, infertility, and infection. However, CPA-associated severe enteritis is a rare adverse effect, and only one case with a lethal clinical course has been reported. Therefore, the appropriate management of patients with CPA-associated severe enteritis is unclear.

CASE SUMMARY

We present the case of a 61-year-old woman diagnosed with granulomatosis with polyangiitis based on the presence of symptoms in ear, lung, and, kidney with positive myeloperoxidase-antineutrophil cytoplasmic antibody. She received pulsed methylprednisolone followed by prednisolone 55 mg/d and intravenous CPA at a dose of 500 mg/mo. Ten days after the second course of intravenous CPA, she developed nausea, vomiting, and diarrhea, and was admitted to the hospital. Laboratory testing revealed hypoalbuminemia, suggesting protein-losing enteropathy. Computed tomography revealed wall thickening of the stomach, small intestine, and colon with contrast enhancement on the lumen side. Antibiotics and immunosuppressive therapy were not effective, and the patient’s enteritis did not improve for > 4 mo. Because her condition became seriously exhausted, corticosteroids were tapered and supportive therapies including intravenous hyperalimentation, replenishment of albumin and gamma globulin, plasma exchange, and infection control were continued. These supportive therapies improved her condition, and her enteritis gradually regressed. She was finally discharged 7 mo later.

CONCLUSION

Immediate discontinuation of CPA and intensive supportive therapy are crucial for the survival of patients with CPA-associated severe enteritis.

Anti-anaemic effect of ethanol leaf extract of Cnidosculus aconitifolius on cyclophosphomide-induced anaemia in rats

BACKGROUND

The folkloric claim that Cnidoscolus aconitifolius (Chaya) could ameliorate anaemia requires scientific revalidation in anaemic models.

OBJECTIVE

The aim of this study is to investigate the anti-anaemic effect of Cnidoscolus aconitifolius on cyclophosphamide-induced anaemia in rats.

METHODS

The leaves of Cnidoscolus aconitifolius were collected, dried and extracted with ethanol. Twenty five Wistar Albino rats weighing 120-180 kg were used. Anaemia was induced in groups 2, 3, 4 and 5 with a single injection of cyclophosphamide, while group 1 served as a negative control without anemia and was treated with 0.5 mL of normal saline, Group 2 rats were treated with 100 mg/kg body weight of Cnidoscolus aconitifolius. Group 3 rats were treated with 500 mg/kg body weight of Cnidoscolus aconitifolius. Group 4 served as the positive control rats and was treated with 0.5 mL of normal saline. Group 5 which served as the standard control rats and were treated with 5 mg/kg body weight of standard drug Chemiron. The treated lasted for two weeks during which blood samples were collected from each rat for haematological analysis.

RESULTS

The result shows that hematological parameters were elevated in groups 2, 3 and 5 rats treated with 100 mg/kg and 500 mg/kg body weight of ethanol extract of Cnidoscolus aconitifolius and chemiron respectively.

CONCLUSIONS

Ethanol leaf extract of Cnidoscolus aconitifolius at a graded dose of 500 mg/kg body weight had higher ameliorative effect on the haematological parameters of cyclophosphamide-induced anemia in rats.

Successful Treatment of IgA Vasculitis Complicated with Bowel Perforation and Crescentic Glomerulonephritis by Combination Therapy of Glucocorticoid, Cyclosporine and Factor XIII Replacement

We report the findings of an 18-year-old boy with immunoglobulin A vasculitis (IgAV) complicated with bowel perforation and nephritis. He presented with abdominal pain, arthralgia and palpable purpura. Massive proteinuria developed during his clinical course. The patient was treated successfully using combination therapy of glucocorticoid (GC), cyclosporine (CYA) and factor XIII (F XIII) replacement. A standard treatment strategy for severe IgAV patients has not been established due to its rarity. Combination therapy using GC, CYA and F XIII replacement should be considered for severe IgAV patients.