Bowel Perforation During Haemophagocytic Lymphohistiocytosis Treatment with Corticosteroids and Anakinra

  • Jan Adamski Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
  • Björn Jäschke Department of Anaesthesiology and Intensive Care, Satakunta Central Hospital, Pori, Finland
  • Tuomas Nieminen Department of Infectious Diseases, Satakunta Central Hospital, Pori, Finland
  • Wojciech Weigl Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

Keywords

Diverticulitis, haemophagocytic lymphohistiocytosis (HLH), gut, interkeukin-1 (IL-1) receptor antagonist, gastrointestinal diseases

Abstract

We report the use of anakinra to treat a case of a 64-year-old man diagnosed with hemophagocytic lymphohistiocytosis (HLH) with neurological involvement. After the administration of intravenous pulse corticosteroid therapy, immunoglobulin, and anakinra, the patient showed neurological recovery. However, the recovery was complicated by the perforation of a pre-existing bowel diverticulum. The effect of anakinra on bowel inflammation has not yet been clearly established. It can potentially augment bowel inflammation and contribute to the risk of bowel perforation associated with the concomitant use of corticosteroids.

VIEW THE ENTIRE ARTICLE

References

  • Mehta P, Cron RQ, Hartwell J, Manson JJ, Tattersall RS. Silencing the cytokine storm: the use of intravenous anakinra in haemophagocytic lymphohistiocytosis or macrophage activation syndrome. Lancet Rheumatol 2020;2:e358–e367.
  • Jagpal A, Curtis JR. Gastrointestinal perforations with biologics in patients with rheumatoid arthritis: implications for clinicians. Drug Saf 2018;41:545–553.
  • La Rosée P, Horne A, Hines M, von Bahr Greenwood T, Machowicz R, Berliner N, et al. Recommendations for the management of hemophagocytic lymphohistiocytosis in adults. Blood 2019;23:2465–2477.
  • Titos-García A, Aranda-Narváez JM, Romacho-López L, González-Sánchez AJ, Cabrera-Serna I, Santoyo-Santoyo J. Nonoperative management of perforated acute diverticulitis with extraluminal air: results and risk factors of failure. Int J Colorectal Dis 2017;32:1503–1507.
  • Thorisson A, Nikberg M, Andreasson K, Smedh K, Chabok A. Non-operative management of perforated diverticulitis with extraluminal or free air - a retrospective single center cohort study. Scand J Gastroenterol 2018;53:1298–1303.
  • Gravante G, Yahia S. Medical influences, surgical outcomes: role of common medications on the risk of perforation from untreated diverticular disease. World J Gastroenterol 2013;19:5947–5952.
  • Kvasnovsky CL, Papagrigoriadis S, Bjarnason I. Increased diverticular complications with nonsteriodal anti-inflammatory drugs and other medications: a systematic review and meta-analysis. Colorectal Dis 2014;16:O189–196.
  • Tursi A, Elisei W. Role of inflammation in the pathogenesis of diverticular disease. Mediators Inflamm 2019;2019:8328490.
  • Bamias G, Arseneau KO, Cominelli F. Cytokines and mucosal immunity. Curr Opin Gastroenterol 2014;30:547–552.
  • Carter JD, Valeriano J, Vasey FB. Crohn disease worsened by anakinra administration. J Clin Rheumatol 2003;9:276–277.
  • Hügle B, Speth F, Haas JP. Inflammatory bowel disease following anti-interleukin-1-treatment in systemic juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2017;15:16.
  • Verheul HM, Pinedo HM. Possible molecular mechanisms involved in the toxicity of angiogenesis inhibition. Nat Rev Cancer 2007;7:475–485.
  • Published: 2021-10-12

    Issue: 2021: Vol 8 No 10 (view)

    Section: Articles

    How to cite:
    1.
    Adamski J, Jäschke B, Nieminem T, Weigl W. Bowel Perforation During Haemophagocytic Lymphohistiocytosis Treatment with Corticosteroids and Anakinra. EJCRIM 2021;8 doi:10.12890/2021_002842.