Tocilizumab dramatically ameliorated life-threatening diarrhea due to secondary amyloidosis associated with rheumatoid arthritis.
Severe diarrhea improved dramatically with administration of the humanized anti-interleukin-6 receptor antibody tocilizumab (TCZ) in a patient with secondary reactive amyloidosis, which was associated with rheumatoid arthritis (RA). A 53-year-old woman with RA went into hypovolemic shock because of severe watery diarrhea associated with gastrointestinal amyloidosis. The high-dose prednisolone therapy and glucocorticoid pulse therapy did not improve her intractable diarrhea. After TCZ administration, the life-threatening diarrhea lessened in about 6 h, and her vital signs became stable the next day. Perforation of the small intestine, however, occurred 2 days after TCZ administration. Whether TCZ could have been involved in the perforation in such a short time is unknown. Surgery was successful, and the patient recovered. TCZ may work immediately in diarrhea associated with secondary amyloidosis.
Sato
Hiroe
H
Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Niigata 957-0054, Japan. hiroe-212@umin.ac.jp
Sakai
Takehito
T
Sugaya
Toshiaki
T
Otaki
Yasuhiro
Y
Aoki
Kana
K
Ishii
Katsushi
K
Horizono
Hidehiro
H
Otani
Hiroshi
H
Abe
Asami
A
Yamada
Noboru
N
Ishikawa
Hajime
H
Nakazono
Kiyoshi
K
Murasawa
Akira
A
Gejyo
Fumitake
F
D000328:Adult; D000686:Amyloidosis / Q000150:complications* / Q000473:pathology; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001706:Biopsy; D003967:Diarrhea / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D019947:Receptors, Interleukin-6 / Q000276:immunology
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D019947:Receptors, Interleukin-6; C502936:tocilizumab