title: Reversal of Refractory Ulcerative Colitis and Severe Chronic Fatigue Syndrome Symptoms Arising from Immune Disturbance in an HLA-DR/DQ Genetically Susceptible Individual with Multiple Biotoxin Exposures.
abstract: BACKGROUND
  Patients with multisymptom chronic conditions, such as refractory ulcerative colitis (RUC) and chronic fatigue syndrome (CFS), present diagnostic and management challenges for clinicians, as well as the opportunity to recognize and treat emerging disease entities. In the current case we report reversal of co-existing RUC and CFS symptoms arising from biotoxin exposures in a genetically susceptible individual.
  
  
  METHODS
  A 25-year-old previously healthy male with new-onset refractory ulcerative colitis (RUC) and chronic fatigue syndrome (CFS) tested negative for autoimmune disease biomarkers. However, urine mycotoxin panel testing was positive for trichothecene group and air filter testing from the patient's water-damaged rental house identified the toxic mold Stachybotrys chartarum. HLA-DR/DQ testing revealed a multisusceptible haplotype for development of chronic inflammation, and serum chronic inflammatory response syndrome (CIRS) biomarker testing was positive for highly elevated TGF-beta and a clinically undetectable level of vasoactive intestinal peptide (VIP). Following elimination of biotoxin exposures, VIP replacement therapy, dental extractions, and implementation of a mind body intervention-relaxation response (MBI-RR) program, the patient's symptoms resolved. He is off medications, back to work, and resuming normal exercise.
  
  
  CONCLUSIONS
  This constellation of RUC and CFS symptoms in an HLA-DR/DQ genetically susceptible individual with biotoxin exposures is consistent with the recently described CIRS disease pathophysiology. Chronic immune disturbance (turbatio immuno) can be identified with clinically available CIRS biomarkers and may represent a treatable underlying disease etiology in a subset of genetically susceptible patients with RUC, CFS, and other immune disorders.
authors.affiliation: Department of Genomic Pathology, Targeted Genomics, San Antonio, TX, USA.
authors.forename: Shelly R
authors.initials: SR
authors.lastname: Gunn
authors.affiliation: Department of Genomic Pathology, Targeted Genomics, San Antonio, TX, USA.
authors.forename: G Gibson
authors.initials: GG
authors.lastname: Gunn
authors.affiliation: Family Practice, Huebner Family Medicine, San Antonio, TX, USA.
authors.forename: Francis W
authors.initials: FW
authors.lastname: Mueller
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000150:complications* / Q000628:therapy; D004781:Environmental Exposure / Q000009:adverse effects*; D015673:Fatigue Syndrome, Chronic / Q000150:complications* / Q000628:therapy; D020022:Genetic Predisposition to Disease / Q000235:genetics*; D006683:HLA-DQ Antigens / Q000235:genetics; D006684:HLA-DR Antigens / Q000235:genetics; D006801:Humans; D008297:Male; D013191:Stachybotrys / Q000472:pathogenicity; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications* / Q000628:therapy; D014255:Trichothecenes
chemical_list: D006683:HLA-DQ Antigens; D006684:HLA-DR Antigens; D014255:Trichothecenes