pulmicort and Lymphoma--Follicular

Recently, there have been a few reports of rituximab (RTX)-induced Crohn's disease, but there is no literature available on successful long-term treatment and the clinical outcome of this condition. We retrospectively analyzed the clinical data of a rare case of Crohn's disease induced by RTX administered as induction and prolonged maintenance therapy of a follicular lymphoma, diagnosed synchronously with a gastric signet ring cells carcinoma, treated at our hospital.

Topics: Anti-Inflammatory Agents; Antineoplastic Agents, Immunological; Budesonide; Carcinoma, Signet Ring Cell; Crohn Disease; Drug Therapy, Combination; Humans; Induction Chemotherapy; Lymphoma, Follicular; Maintenance Chemotherapy; Male; Mesalamine; Middle Aged; Neoplasms, Multiple Primary; Rituximab; Stomach Neoplasms; Treatment Outcome

The introduction of immune-checkpoint inhibitors (ICPI) in recent years has changed the natural course of many neoplasms. However, patients receiving these medications may present immune-mediated adverse events; management includes temporary or permanent cessation of treatment and corticosteroids, occasionally combined with other immunomodulators. Such immunosuppression, however, also has numerous adverse events and even if it is effective in controlling toxicity, it delays immunotherapy reinitiation, as current evidence requires dose tapering to ≤10 mg prednisolone equivalent before rechallenge. Enteric-coated budesonide is a corticosteroid formulation acting primarily to the intestine and liver, as a result of its extensive first-pass hepatic metabolism.. A 76-year-old woman treated with ipilimumab for metastatic melanoma presented with abdominal pain, vomiting, and diarrhea for at least the previous 4 days. Laboratory tests, among others, revealed elevated aminotransferases and C-reactive protein. During hospitalization, the patient also developed fever.. The patient, after excluding alternative causes of aminotransferase elevation, was diagnosed with grade 3 ipilimumab-associated hepatotoxicity.. Budesonide monotherapy was administered; initial daily dose was 12 mg.. Fever subsided after the first dose of budesonide. Aminotransferases returned to normal-near normal approximately 1 month after the first dose of budesonide. After this point, daily dose was reduced by 3 mg every 2 weeks, with no clinical or biochemical relapse.. This case of ICPI hepatitis is, to our knowledge, the first in the literature managed with budesonide monotherapy. Therefore, budesonide may be a potentially attractive option for the management of ICPI-associated liver injury in cases where corticosteroid treatment is necessary due to its safety profile and the potential advantage of faster immunotherapy rechallenge in selected patients without requiring dose tapering, in contrast to systemically acting corticosteroids. Clinical trials should be conducted in the future in order to validate or refute these findings.

Topics: Aged; Budesonide; Chemical and Drug Induced Liver Injury; Female; Humans; Immune Checkpoint Inhibitors; Ipilimumab; Lymphoma, Follicular; Melanoma; Transaminases

Local immunosuppressive therapies without systemic effects represent a therapeutic advantage in management of immune/inflammatory oral mucosal conditions. Topical budesonide rinses were prescribed to patients with mucosal disease that was resistant to other intervention without side effects. A case of paraneoplastic pemphigus and a patient with oral graft-versus-host disease that had not responded to standard approaches to management were successfully managed with budesonide rinse application. The cases presented represent mucosal conditions that were successfully managed with topical application of budesonide with reduced risk of systemic effects.

Topics: Anti-Inflammatory Agents; Budesonide; Graft vs Host Disease; Humans; Immunosuppressive Agents; Leukemia, Lymphoid; Lymphoma, Follicular; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Mouthwashes; Mucocele; Neutrophil Infiltration; Paraneoplastic Syndromes; Pemphigus