title: Primary Manifestation of Inflammatory Bowel Disease Following Subcutaneous Autovaccination.
abstract: Onset of inflammatory bowel disease [IBD] is nowadays seen as an interplay or a combination of genetic susceptibility, disturbed intestinal immunity, and environmental factors including gut microbiome. However, the initiation of inflammation and progression to IBD pathogenesis in a given individual is poorly understood. In this case report we describe the clinical course of a 17-year-old female patient developing symptoms suggestive of IBD after 'autovaccine therapy', in which sterilised samples of the patient's own stool were injected subcutaneously for improvement of her general immunity. The patient presented with a severe onset of disease, which was first suspected to be ulcerative colitis on outpatient examination and was later corrected to IBD with Crohn's-like features due to high systemic inflammation, mixed lymphocytic-granulocytic infiltrates in gastric biopsies, and further characteristics suggestive of Crohn's disease. A prolonged and complicated course was seen with intermittent steroid dependency in the long term. Numerous publications postulate that [auto-]immune reactions against resident bacterial stool flora may play a role in IBD. It is possible that in this patient tolerance to endogenous bacteria was disrupted by systemic pro-inflammatory mechanisms induced by autovaccination.
authors.affiliation: Department of Medicine 1, Gastroenterology, University of Erlangen, Erlangen, Germany martin.raithel@uk-erlangen.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Raithel
authors.affiliation: Private Practice for Gastroenterology, Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Weidenhiller
authors.affiliation: Department of Anaesthesiology, Kantonsspital Baselland, Liestal, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Hahn
authors.affiliation: Department of Medicine 1, Gastroenterology, University of Erlangen, Erlangen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hagel
authors.affiliation: Department of Medicine 1, Gastroenterology, University of Erlangen, Erlangen, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bechthold
authors.affiliation: Department of Medicine 1, Gastroenterology, University of Erlangen, Erlangen, Germany.
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
authors.affiliation: Department of Pathology, University of Erlangen, Erlangen, Germany.
authors.forename: Ralf J
authors.initials: RJ
authors.lastname: Rieker
authors.affiliation: Department of Nutritional Medicine, Sachsenhausen University Hospital, Frankfurt/Main, Germany Crohn-Colitis Centre Rhein-Main, Frankfurt/Main, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D054991:Autovaccines / Q000009:adverse effects*; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000276:immunology* / Q000382:microbiology; D007279:Injections, Subcutaneous
chemical_list: D054991:Autovaccines
keywords: Crohn’s; IBD; autoimmunity; autovaccination; autovaccine therapy; stool flora