Gold colitis induced by auranofin treatment of rheumatoid arthritis: case report and review of the literature.

Abstract

SUMMARY A case of ulcerative colitis occurred during treatment of rheumatoid arthritis with the new oral gold preparation auranofin after a cumulative dose of 2160 mg. A barium enema showed loss of mucosal pattern and a rectal biopsy disclosed deep erosions, mucosal inflammation, and crypt abscesses. Precipitates of gold were seen in the periglandular stroma. On electron microscopy the gold deposits seemed to be identical to granules described in gold nephropathy. As the extrapolated serum gold level was within the normal range at the onset of the complication, the morphological findings suggested a local toxicity of the drug. The patient recovered within 14 days of withdrawal of auranofin and the start of therapy with sulphasalazine and steroids. A review of the published work shows that the previously reported mortality in gold colitis of 40% has decreased in recent years. The causes of this decrease may be both the earlier diagnosis of gold colitis and the improved intensive care of its severe complications.

Adjunctive host-directed therapies for pulmonary tuberculosis: a prospective, open-label, phase 2, randomised controlled trial

“… 15 Several cases of severe colitis due to gold therapy regardless of the route of administration have been reported; rare reports also describe colon perforation. 36 , 37 Although most cases occurred after many months of treatment, one report describes severe colitis occurring after 4 weeks of treatment with auranofin. 38 For this reason, we were unable to exclude auranofin as a possible cause of death in one patient who had intra-abdominal sepsis, and classified the adverse event as a suspected unexpected serious adverse reaction.…”

Intracellular gold nanoparticles enhance non-invasive radiofrequency thermal destruction of human gastrointestinal cancer cells

“…Parenteral gold typically causes side effects in about 35% of patients, which can include dermatitis, diarrhea, or stomatitis. More severe reactions such as nephritis, bone marrow suppression, colitis, and hepatotoxicity are more rarely observed [ 28 , 29 ]. While the toxicity profile for colloidal gold and GNPs does not demonstrate any hematologic or biochemical sequelae, these gold formulations are not currently used in the treatment of rheumatoid arthritis [ 30 ].…”

Gold Nanoparticles: A Revival in Precious Metal Administration to Patients

“…9, 47 Hematological abnormalities can also be sometimes produced by gold complexes and include eosinophilia, thrombocytopenia 9 and rarely aplastic anaemia probably as a result of a direct inhibition of myelopoiesis. 48 Several other reports have also mentioned the rare consequences of using gold complexes including entercolitis with bloody diarrhea, 49, 50 diffuse inflammatory lung reactions 51 and neurotoxicity. 52 Gold therapy is not recommended during pregnancy, 53 as animal studies have shown it to be teratogenic.…”