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.
Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Niigata 957-0054, Japan. hiroe-212@umin.ac.jp
Hiroe
H
Sato
Takehito
T
Sakai
Toshiaki
T
Sugaya
Yasuhiro
Y
Otaki
Kana
K
Aoki
Katsushi
K
Ishii
Hidehiro
H
Horizono
Hiroshi
H
Otani
Asami
A
Abe
Noboru
N
Yamada
Hajime
H
Ishikawa
Kiyoshi
K
Nakazono
Akira
A
Murasawa
Fumitake
F
Gejyo
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