Academic Journal
Rituximab-associated colitis with colonic perforation requiring subtotal colectomy in systemic sclerosis.
| Τίτλος: | Rituximab-associated colitis with colonic perforation requiring subtotal colectomy in systemic sclerosis. |
|---|---|
| Συγγραφείς: | Kuhara Y; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 3-2-1, Kasumi, Minami-ku, 734-8551, Hiroshima, Japan. y.kuhara010613@gmail.com.; Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, 734-8551, Japan. y.kuhara010613@gmail.com., Uegami S; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 3-2-1, Kasumi, Minami-ku, 734-8551, Hiroshima, Japan., Miyata M; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 3-2-1, Kasumi, Minami-ku, 734-8551, Hiroshima, Japan., Okazawa Y; Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, 734-8551, Japan., Doi H; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 3-2-1, Kasumi, Minami-ku, 734-8551, Hiroshima, Japan., Shimbara K; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 3-2-1, Kasumi, Minami-ku, 734-8551, Hiroshima, Japan., Kitagawa H; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 3-2-1, Kasumi, Minami-ku, 734-8551, Hiroshima, Japan.; Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, 734-8551, Japan., Arihiro K; Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, 734-8551, Japan., Takahashi S; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 3-2-1, Kasumi, Minami-ku, 734-8551, Hiroshima, Japan., Ohge H; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 3-2-1, Kasumi, Minami-ku, 734-8551, Hiroshima, Japan.; Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, 734-8551, Japan. |
| Πηγή: | Clinical journal of gastroenterology [Clin J Gastroenterol] 2026 Aug; Vol. 19 (4), pp. 847-855. Date of Electronic Publication: 2026 May 19. |
| Τύπος έκδοσης: | Journal Article; Case Reports |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer Japan Country of Publication: Japan NLM ID: 101477246 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1865-7265 (Electronic) Linking ISSN: 18657265 NLM ISO Abbreviation: Clin J Gastroenterol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [Tokyo] : Springer Japan |
| Ιατρικοί όροι (MeSH): | Rituximab*/adverse effects , Intestinal Perforation*/surgery , Intestinal Perforation*/chemically induced , Intestinal Perforation*/diagnostic imaging , Colitis*/chemically induced , Colitis*/surgery , Colitis*/diagnostic imaging , Colectomy*/methods , Scleroderma, Systemic*/drug therapy , Scleroderma, Systemic*/complications, Humans ; Female ; Adult ; Colonoscopy |
| Περίληψη: | Rituximab-associated colitis, a rare toxicity that may occur following prolonged latency, has nonspecific features. We report a 42-year-old female with diffuse cutaneous systemic sclerosis and interstitial lung disease whose last rituximab infusion was 195 days before admission. She developed diarrhea and abdominal pain; initial computed tomography revealed no intra-abdominal focus. On day 12, colonoscopy revealed erosions and ulcers from the cecum to the descending colon; cytomegalovirus testing was negative. Symptoms persisted; repeat colonoscopy on day 20 confirmed multifocal ulceration, suggesting cytomegalovirus colitis or severe Crohn's disease. By day 27, computed tomography showed ascending colon thinning, descending colon thickening, and haustral loss like ulcerative colitis. High-dose prednisolone was initiated owing to the inflammatory bowel disease-like process. Although clinical symptoms and inflammatory markers were improved, follow-up computed tomography revealed free air and perforation, necessitating emergency subtotal colectomy with ileostomy. Histology demonstrated ulcers extending to the subserosa, and noncaseating granulomas in the mucosa and submucosa. Immunohistochemistry demonstrated CD3-positive, CD20-negative, and CD4-predominant lymphocytic infiltration. This case highlights that rituximab-associated colitis may mimic inflammatory bowel disease, show prolonged latency, and progress to perforation despite apparent biochemical improvement, warranting early biopsy and careful radiologic follow-up. Rituximab-associated colitis should be considered even months following anti-CD20 exposure. (© 2026. The Author(s), under exclusive licence to Japanese Society of Gastroenterology.) |
| Competing Interests: | Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: The patient consented to the reporting of this case in a scientific publication. Competing interests: The authors declare that they have no competing interests. |
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| Contributed Indexing: | Keywords: Colitis; Inflammatory bowel disease; Intestinal perforation; Rituximab; Scleroderma systemic |
| Substance Nomenclature: | 4F4X42SYQ6 (Rituximab) |
| Entry Date(s): | Date Created: 20260519 Date Completed: 20260730 Latest Revision: 20261010 |
| Update Code: | 20261010 |
| DOI: | 10.1007/s12328-026-02358-5 |
| PMID: | 42154385 |
| Βάση Δεδομένων: | MEDLINE |
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