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Endoscopic image. B. Pathology: gastric cancer with lymphoid stroma (GMC). Irregular sheets and trabeculae of polygonal cells with prominent lymphocytic infiltrate. C. CT of abdomen: parietal thickening in gastric antrum.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "David Hernandez Bermejo, Silvia Carbonell Morote, Cristina Alenda, Sergio Ortiz, Ester Gracia, Emilio Ruiz de la Cuesta, Jose Luis Estrada, Jose Manuel Ramia" "autores" => array:8 [ 0 => array:2 [ "nombre" => "David" "apellidos" => "Hernandez Bermejo" ] 1 => array:2 [ "nombre" => "Silvia" "apellidos" => "Carbonell Morote" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "Alenda" ] 3 => array:2 [ "nombre" => "Sergio" "apellidos" => "Ortiz" ] 4 => array:2 [ "nombre" => "Ester" "apellidos" => "Gracia" ] 5 => array:2 [ "nombre" => "Emilio" "apellidos" => "Ruiz de la Cuesta" ] 6 => array:2 [ "nombre" => "Jose Luis" "apellidos" => "Estrada" ] 7 => array:2 [ "nombre" => "Jose Manuel" "apellidos" => "Ramia" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210570523003667" "doi" => "10.1016/j.gastrohep.2023.06.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570523003667?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382424000579?idApp=UINPBA00004N" "url" => "/24443824/0000004700000004/v1_202405220556/S2444382424000579/v1_202405220556/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Beyond Crohn's disease: Deferasirox as possible agent for drug-induced ileocolitis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "380" "paginaFinal" => "381" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Esteban Fuentes-Valenzuela, Ana Yaiza Carbajo, Samuel Juan Fernández-Prada, Beatriz Madrigal Rubiales, Natalia Carpizo Jimenez" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Esteban" "apellidos" => "Fuentes-Valenzuela" "email" => array:1 [ 0 => "estebanfuentes_2@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana Yaiza" "apellidos" => "Carbajo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Samuel Juan" "apellidos" => "Fernández-Prada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Beatriz Madrigal" "apellidos" => "Rubiales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Natalia Carpizo" "apellidos" => "Jimenez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Gastroenterology Department, Hospital Universitario Rio Hortega, C. Dulzaina, 2, 47012 Valladolid,Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pathology Department, Hospital Universitario Rio Hortega, C. Dulzaina, 2, 47012 Valladolid,Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hematology Department, Hospital Universitario Rio Hortega, C. Dulzaina, 2, 47012 Valladolid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Más allá de la enfermedad de Crohn. Deferasirox como posible agente etiológico de ileocolitis farmacológica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1505 "Ancho" => 1874 "Tamanyo" => 478991 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A: notice the right colonic wall thickening. B: Diffuse ileitis with large superficial and ulcers in the terminal ileum. C: Pathological study revealed non-specific features with neutrophilic, eosinophilic and lymphocytic infiltration. D: A second colonoscopy 4 months later showing mucosal healing in the terminal ileum.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 72-years-old female with a history of paroxysmal supraventricular tachycardia and myelodysplastic syndrome (sideroblastic anemia) with iron overload. She was treated with bisoprolol and deferasirox for three years. She was admitted to our gastroenterology department for abdominal pain in the lower right quadrant and chronic watery diarrhea. An abdominal CT scan with intravenous contrast revealed a cecal and terminal ileum wall thickening (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Blood test showed a normocitic anemia (Hb 8.5<span class="elsevierStyleHsp" style=""></span>g/dl) and ferritin<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>1500. Stool cultures were negative for bacteria, virus and parasites. Thus, a colonoscopy was scheduled and revealed a diffuse ileitis with large superficial and geographic ulcers in the terminal ileum (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) The surrounding mucosa showed particularly atrophic mucosa and villis. Also, small erosions were observed in the right colon with a surrounding edematous mucosa with unremarkable mucosa in the rest of the colon. Multiples biopsies were taken and showed neutrophilic, eosinophilic and lymphocytic infiltration with non-specific microscopic features (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The differential diagnosis included infectious ileocolitis, drug-induced ileocolitis and Crohn's disease. So, after multidisciplinary consensus, deferasirox was withdrawn. Rapid clinical improvement within days was noticed. A colonoscopy was repeated 4 months later showing mucosal healing and some scarce edematous mucosa without any ulcer neither erosion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D).</p><p id="par0015" class="elsevierStylePara elsevierViewall">NSAIDs have been proposed as a clear risk factor for small bowel induced damage, with a prevalence of mucosal breaks in around 50% in chronic users.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Other drugs as antihypertensives, digoxin, enteric-coated hydrochlorothiazide with potassium, ergotamine and oral contraceptives have been described as conditions related development of terminal ileitis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Deferasirox is an oral iron chelator commonly used in thalassemia. Some gastrointestinal side effects as diarrhea have been described, including duodenal and gastric ulcers.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> Although, terminal ileitis and colitis has not been previously described for deferasirox. After proper differential diagnosis and according to the WHO UMC causality categories, this case could be classified as possible due a second endoscopic procedure confirming the healing of the mucosa after drug withdrawal but the rechallenge was considered too risky.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Moreover, gastric and duodenal ulcers have been described as adverse events in patients taking deferasirox. In this setting, the use of deferasirox should be discontinued, due to risk of perforation. This reason motivated the drug withdrawal in our case and after the repeated endoscopic procedure we choose to not resume.</p><p id="par0025" class="elsevierStylePara elsevierViewall">As conclusions, a wide differential diagnosis should be mandatory in ileocolitis including pharmacological etiology as possible agent.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1505 "Ancho" => 1874 "Tamanyo" => 478991 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A: notice the right colonic wall thickening. B: Diffuse ileitis with large superficial and ulcers in the terminal ileum. C: Pathological study revealed non-specific features with neutrophilic, eosinophilic and lymphocytic infiltration. D: A second colonoscopy 4 months later showing mucosal healing in the terminal ileum.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current knowledge on non-steroidal anti-inflammatory drug-induced small-bowel damage: a comprehensive review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Watanabe" 1 => "Y. Fujiwara" 2 => "F.K.L. Chan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/S00535-019-01657-8" "Revista" => array:6 [ "tituloSerie" => "J Gastroenterol" "fecha" => "2020" "volumen" => "55" "paginaInicial" => "481" "paginaFinal" => "495" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31865463" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Facing terminal ileitis: going beyond Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.A. Goulart" 1 => "S.M. Barbalho" 2 => "R.G. 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Available at <a target="_blank" href="https://www.who.int/publications/m/item/WHO-causality-assessment">https://www.who.int/publications/m/item/WHO-causality-assessment</a>." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004700000004/v1_202405220556/S2444382424002001/v1_202405220556/en/main.assets" "Apartado" => array:4 [ "identificador" => "77930" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004700000004/v1_202405220556/S2444382424002001/v1_202405220556/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382424002001?idApp=UINPBA00004N" ]
Journal Information
Vol. 47. Issue 4.
Pages 380-381 (April 2024)
Vol. 47. Issue 4.
Pages 380-381 (April 2024)
Scientific letter
Beyond Crohn's disease: Deferasirox as possible agent for drug-induced ileocolitis
Más allá de la enfermedad de Crohn. Deferasirox como posible agente etiológico de ileocolitis farmacológica
Esteban Fuentes-Valenzuelaa,
, Ana Yaiza Carbajoa, Samuel Juan Fernández-Pradaa, Beatriz Madrigal Rubialesb, Natalia Carpizo Jimenezc
Corresponding author
a Gastroenterology Department, Hospital Universitario Rio Hortega, C. Dulzaina, 2, 47012 Valladolid,Spain
b Pathology Department, Hospital Universitario Rio Hortega, C. Dulzaina, 2, 47012 Valladolid,Spain
c Hematology Department, Hospital Universitario Rio Hortega, C. Dulzaina, 2, 47012 Valladolid, Spain
Article information
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