Adult autoimmune enteropathy treated successfully with tacrolimus.
BACKGROUND
Autoimmune enteropathy is a life-threatening, chronic disease of the small bowel mucosa, which generally responds well to steroids. Treatment requires long-term immunosuppression, and steroid-sparing treatment strategies are desirable. Azathioprine and cyclosporine A have limitations, however alternatives have not been described in adults.


METHODS
We present the case of a 54-year-old male patient with autoimmune enteropathy who responded initially to a standard treatment with steroids, but was dependent on 30 mg prednisolone. Medical treatment was changed to tacrolimus after renal function deteriorated under treatment with cyclosporine A. Under this regimen, small bowel histology normalized and the clinical condition is stable after 2 years of introduction of tacrolimus.


CONCLUSIONS
This constitutes the first report of effective treatment of adult autoimmune enteropathy with tacrolimus, a substance with a similar mode of action to cyclosporine, but with fewer side effects and improved bioavailability.
Department of Medicine I, Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. severin.daum@medizin.fu-berlin.de
Severin
S
Daum
Ergün
E
Sahin
Andreas
A
Jansen
Bernhard
B
Heine
Ernst-Otto
EO
Riecken
Martin
M
Zeitz
Wolfgang
W
Schmidt
D000284:Administration, Oral; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000473:pathology; D004386:Duodenum / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007410:Intestinal Diseases / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016559:Tacrolimus / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D016559:Tacrolimus