Association between myelodysplastic syndromes and inflammatory bowel diseases. Report of seven new cases and review of the literature

Abstract

We report seven patients with both myelodysplastic syndrome (MDS) and inflammatory bowel disease (IBD): Crohn's disease in six cases, ulcerative colitis in one case. We describe their characteristics, and those of 10 previously published similar cases are presented here. Median age at diagnosis of IBD (61 years) was high, as compared to the usual age at diagnosis of IBD. IBD was diagnosed first in nine cases, MDS first in one patient, and both diseases were diagnosed simultaneously in seven cases. Concerning IBD, there was a strong predominance of Crohn's disease (15/17 cases), with an unusually high frequency of colonic involvement (11/15 cases). MDS, in 12/17 cases, showed no excess of marrow blasts. Cytogenetic analysis was abnormal in five of the 13 evaluable cases. These observations suggest that the association between MDS and IBD may not be fortuitous in some cases, and that, in particular, patients with IBD and anemia of nonobvious origin should be evaluated for MDS. The pathogenesis of those associations, however, remains unclear.

Concurrent Inflammatory Bowel Disease and Myelodysplastic Syndrome: Report of Nine New Cases and a Review of the Literature

“…An earlier publication reported an incidence of 25 MDS patients in 15,000 cases of IBD, making the incidence rate of MDS in the IBD population 170 in 100,000 [4], which is much higher than that found in the common population. In another sample of 845 MDS patients, there were four cases of IBD, resulting in an incidence rate of 550 in 100,000 [5], a figure five to tenfold higher than that in the common population.…”

“…However, when leukopenia and thrombocytopenia are present, the possibility of other concomitant diseases (such as idiopathic thrombocytopenic purpura and pancytopenia caused by drugs) should be considered. In recent years, there have been some reports of concurrent IBD with leukemia and myelodysplastic syndrome (MDS) [2][3][4][5][6][7][8][9], but concurrent IBD and MDS cases are rare. In this study, we report nine patients with concurrent MDS and IBD treated between January 1985 and October 2006.…”

Extraintestinal Manifestations of Ulcerative Colitis

“…Idiopathic thrombocytopenic purpura (ITP), documented by various case reports to occur in patients with UC, is autoimmune in nature and treatment is similar to that of AIHA with steroids, splenectomy, and if necessary, colectomy (Mizuta et al, 2003;Yoshida et al, 1996). Various hematologic malignancies have been reported as UC complications and include: acute promyelocytic leukemia, acute myelogenous leukemia, chronic granulocytic leukemia, and myelodysplastic syndrome (Braverman & Bogoch, 1978;Fabry et al, 1980;Hebbar et al, 1997;Rosen & Teplitz, 1965). However, the pathogenesis of the association remains unclear (Fabry, Sachar et al, 1980;Hebbar, Kozlowski et al, 1997;Rosen & Teplitz, 1965;Suzuki et al, 1995).…”

Untitled

“…Other rare hematologic manifestations associated with UC include myelodysplastic syndromes and leukemia. Several investigators have suggested a clinical association between inflammatory bowel disease and myelodysplastic syndrome, since they share an immune dysfunction that impairs the activities of T-lymphocytes (3)(4)(5)(6). UC is an inflammatory bowel disease of unknown etiology that mainly affects the mucosa of the rectum and colon.…”