Hemophagocytic lymphohistiocytosis in Crohnʼs disease associated with primary infection by Epstein–Barr virus

Salado, Claudio Trigo; Gallego, Álvaro Giráldez; Carnerero, Eduardo Leo; Ramírez, Dolores De la Cruz; Justiniano, José Manuel Herrera; Galán, José Luis Márquez; Guisado, Manuela Aguilar

doi:10.1002/ibd.21827

Cited by 12 publications

(7 citation statements)

References 8 publications

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“…Hence, illness due to EBV is characterized by lymphocytosis and lymphadenopathy. 45 Most of the severe EBV diseases in immunosuppressed patients occur during primary infection; hence, it may be reasonable to check EBV serology before instituting thiopurines, as evidence of previous EBV infection would mean a significantly lower risk of mononucleosis. [41][42][43] There have been case reports of fatal EBV infection in patients with Crohn's disease (CD) on azathioprine, who failed to respond to high-dose steroids, intravenous immunoglobulin, acyclovir, and plasmapheresis.…”

Section: Epstein-barr Virusmentioning

confidence: 99%

Opportunistic Infections Due to Inflammatory Bowel Disease Therapy

Dave

Purohit

Razonable

et al. 2014

Inflammatory Bowel Diseases

116

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The use of biological agents and immunomodulators for inflammatory bowel disease (IBD) has remarkably improved disease management in the current era but at the same time has increased the risk of infectious complications. Patients with IBD on corticosteroids, immunomodulators, and biological agents are considered immunocompromised and are at risk for opportunistic infections. These are infections caused by organisms that take advantage of a weakened immune system, and cause disease, when they ordinarily would cause mild illness or no disease in an immunocompetent host. Risk factors for opportunistic infections include malnutrition, older age, congenital immunodeficiency, HIV infection, chronic diseases, and use of corticosteroids, immunomodulators, and anti-tumor necrosis factor alpha therapy. Apart from immunosuppressive medications and older age, there is only indirect evidence for above risk factors contributing directly to opportunistic infection risk in patients with IBD. Opportunistic infections in patients with IBD include viral infections (herpes viruses, human papillomavirus, influenza virus, and JC virus), bacterial infections (tuberculosis, nocardiosis, Clostridium difficile infection, pneumococcal infection, legionellosis, and listeriosis), fungal infections (histoplasmosis, cryptococcosis, Pneumocystis jirovecii infection, aspergillosis, and candidiasis), and parasite infections (Strongyloides stercoralis). Although these infections lead to high morbidity and mortality, only a minority of patients with IBD develop opportunistic infections. Currently, we lack a test to accurately predict patients at risk of opportunistic infection, and future research needs to focus on biomarkers or predictive models for risk stratification. Until such a test is developed, we need to screen, prevent, diagnose, and treat opportunistic infections in all patients with IBD in a timely manner.

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Section: Epstein-barr Virusmentioning

confidence: 99%

Opportunistic Infections Due to Inflammatory Bowel Disease Therapy

Dave

Purohit

Razonable

et al. 2014

Inflammatory Bowel Diseases

116

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“…We identified 50 cases of MAS associated with IBD including two unpublished cases from our clinic and one case from the IBD‐centre of Palermo (Table ),. The first report was published in 1988 followed by six isolated reports over the following 16 years, up to 2004.…”

Section: Resultsmentioning

confidence: 99%

Systematic review: macrophage activation syndrome in inflammatory bowel disease

Fries

Cottone

Cascio

2013

Aliment Pharmacol Ther

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Section: Immunomodulatorsmentioning

confidence: 99%

“…60 Whereas CMV (also a common cause 61 ) can be treated with ganciclovir, there is no effective treatment for EBV, making this syndrome especially lethal, although there have been some small successes with the chemotherapeutic agent etoposide. 60 For causes unclear, the incidence of RHS is increased for males and those with CD. 58 Thus, for this reason and the increased risk for hepatosplenic T cell lymphoma (HSTCL, not associated with EBV, discussed below), the risks and benefits of thiopurines must be weighed more cautiously in the treatment of young male patients.…”

Section: Immunomodulatorsmentioning

confidence: 99%

Understanding the Cautions and Contraindications of Immunomodulator and Biologic Therapies for Use in Inflammatory Bowel Disease

Cohn

Dave

Loftus

2017

Inflammatory Bowel Diseases

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Ulcerative colitis and Crohn’s disease are chronic inflammatory bowel diseases for which there are no cures. These diseases are immunopathogenic, and medical treatment is centered on the temperance of a dysregulated immune response to allow mucosal healing and prevent the sequelae of fistulation and stenosis. Accordingly, the armamentarium of medications, which has expanded immensely in recent history, is not without significant infectious and neoplastic risks. Many of these untoward effects can be mitigated by screening and avoidance of contraindicated medications. This review seeks to highlight the cautions for use of immunomodulators, anticytokine and α4-integrin antagonists. The potential adverse events are further complicated by substantial heterogeneity in disease phenotype in the IBD population. Large patient registries and databases provide considerable experience and knowledge to calculate the incidence of safety outcomes. To identify rarer outcomes after prolonged therapy, more prospective studies and continued adverse event reporting will aid safe application and minimize potential harms.

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Hemophagocytic lymphohistiocytosis in Crohnʼs disease associated with primary infection by Epstein–Barr virus

Cited by 12 publications

References 8 publications

Opportunistic Infections Due to Inflammatory Bowel Disease Therapy

Opportunistic Infections Due to Inflammatory Bowel Disease Therapy

Systematic review: macrophage activation syndrome in inflammatory bowel disease

Understanding the Cautions and Contraindications of Immunomodulator and Biologic Therapies for Use in Inflammatory Bowel Disease

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