High expression of intestinal-type mucin (MUC2) in intraductal papillary mucinous neoplasms coexisting with extrapancreatic gastrointestinal cancers
- KT Jang
To the Editor : We read with interest the letter by Tursi and Penna (1) describing the onset of colitis following treatment with adalimumab. Although development or relapse of colitis following immunosuppressive therapy is well established (2) , reports following monoclonal antibody therapy are scarce. In addition to the case by Tursi and Penna, exacerbations of colitis following use of the anti-CD20 antibody rituximab (3) and the tumor necrosis factorα inhibitor, etanercept (4) have been documented . We report a case of apparent ulcerative colitis in a man who recently commenced the anti-CD11a monoclonal antibody efalizumab (Raptiva, Genentech Inc., San Francisco, CA). E e 34-year-old patient presented with bloody diarrhea and abdominal pain accompanied by fever, tachycardia, and abdominal tenderness. He had a history of psoriasis for which he had been started on subcutaneous efalizumab (Raptiva ), at a dose of 1 mg / kg, 4 weeks before the onset of his symptoms. Plain abdominal radiograph demonstrated a dilated, edematous colon. Flexible sigmoidoscopy demonstrated severe colitis with deep mucosal ulceration ( Figure 1 ). Histology of the inU amed colonic mucosa demonstrated acute and chronic inU ammation with cryptitis and cryptic abscesses. Stool culture was negative for bacterial, parasitic, and viral infections. A diagnosis of fulminant ulcerative colitis was made and the patient was started on intravenous hydrocortisone 400 mg daily and oral mesalamine 2 g twice daily. E e symptoms improved promptly and dramatically. Repeat colonoscopy demonstrated signi& cant mucosal healing ( Figure 2 ). E e patient was discharged well on mesalamine and a reducing dose of oral prednisone. E is case scores 5 on the Naranjo adverse drug reaction assessment tool (5) , indicating probable causation for efalizumab. Efalizumab is a monoclonal antibody directed against the CD11a subunit of lymphocyte function-associated Figure 1 . Colonoscopic image at initial presentation demonstrating mucosal ulceration with surrounding infl ammation.