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

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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.

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Acknowledgements

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., St Louis, MO, 63104, USA

    Muhammad Bader Hammami

  2. Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA

    Ahmad Al-Taee

  3. Saint Louis University School of Medicine, St. Louis, MO, USA

    Marshall Meeks

  4. Division of Hematology and Oncology, Saint Louis University School of Medicine, St. Louis, MO, USA

    Mark Fesler

  5. Department of Dermatology, Saint Louis University School of Medicine, St. Louis, MO, USA

    M Yadira Hurley

  6. Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA

    Dengfeng Cao

  7. Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, USA

    Jin-Ping Lai

Authors
  1. Muhammad Bader Hammami
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  2. Ahmad Al-Taee
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  3. Marshall Meeks
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  4. Mark Fesler
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  5. M Yadira Hurley
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  6. Dengfeng Cao
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  7. Jin-Ping Lai
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Corresponding author

Correspondence to Muhammad Bader Hammami.

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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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Hammami, M.B., Al-Taee, A., Meeks, M. et al. Idelalisib-induced colitis and skin eruption mimicking graft-versus-host disease . Clin J Gastroenterol 10, 142–146 (2017). https://doi.org/10.1007/s12328-016-0707-y

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  • DOI: https://doi.org/10.1007/s12328-016-0707-y

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