Successful use of TNFα blockade in a severe case of idiopathic non-granulomatous ulcerative jejunoileitis associated with thrombotic thrombocytopenic purpura.

BMJ Open Gastroenterol 2019 8;6(1):e000252. Epub 2019 Feb 8.

Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.

We describe the case of 50-year-old female patient who presented with severe gastrointestinal symptoms and progressive weight loss of unknown origin. Shortly after admission, she developed an acute flare of thrombotic thrombocytopaenic purpura (TTP) that had to be treated by plasma exchange therapy and rituximab administration. While the signs of TTP subsided, the gastrointestinal symptoms worsened with abdominal cramps, massive gastric retention, malnourishment and a stenosis due to extensive inflammation and wall thickening of the small bowel. Extensive diagnostic efforts yielded no specific cause, so the patient-based on the histopathological findings-was diagnosed with idiopathic non-granulomatous ulcerative jejunoileitis. Following a highly complicated clinical course over several months, successful remission of the inflammatory activity and recovery of the patient could be obtained by TNF-alpha blockade.

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http://dx.doi.org/10.1136/bmjgast-2018-000252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398868PMC

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February 2019
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References

(Supplied by CrossRef)
Nongranulomatous ulcerative jejunoileitis
Freeman et al.
Am J Gastroenterol 1984
Nongranulomatous ulcerative jejunoileitis with hypogammaglobulinemia. clinical remission after treatment with -globulin
Corlin et al.
Gastroenterology 1972
Inhibition of TNF-α improves indomethacin (indo)-induced jejunoileitis in rats by modulating iNOS expression
Saud et al.
Am J Gastroenterol 2003

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