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

作     者：Hiroko Sato Tsuyoshi Shirai Hiroshi Fujii Tomonori Ishii Hideo Harigae 

作者机构：Department of Hematology and RheumatologyTohoku University Graduate School of MedicineSendai 9808574Japan 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2021年第27卷第20期

页      面：2657-2663页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Funding for Scientific Research(Funding for Academic Research) No.18K16136 

主　　题：Antineutrophil cytoplasmic antibody Cyclophosphamide Enteritis Granulomatosis with polyangiitis Plasma exchange Vasculitis Case report 

摘      要：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 ***,CPA-associated severe enteritis is a rare adverse effect,and only one case with a lethal clinical course has been ***,the appropriate management of patients with CPA-associated severe enteritis is *** 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 *** received pulsed methylprednisolone followed by prednisolone 55 mg/d and intravenous CPA at a dose of 500 mg/*** days after the second course of intravenous CPA,she developed nausea,vomiting,and diarrhea,and was admitted to the *** testing revealed hypoalbuminemia,suggesting proteinlosing *** tomography revealed wall thickening of the stomach,small intestine,and colon with contrast enhancement on the lumen *** and immunosuppressive therapy were not effective,and the patient’s enteritis did not improve for4 *** 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 *** supportive therapies improved her condition,and her enteritis gradually *** was finally discharged 7 mo *** Immediate discontinuation of CPA and intensive supportive therapy are crucial for the survival of patients with CPA-associated severe enteritis.