tacrolimus and Celiac-Disease

Treatment of primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) with ursodeoxycholic acid (UDCA) has been in common use since 1985. In PBC, treatment with UDCA improves laboratory data, liver histology, enables a longer transplantation-free interval and prolongs disease survival. Because UDCA is unable to cure the disease newer drugs or combination therapies are still needed. Studies with UDCA and immunosuppressants such as prednisone, budesonide and azathioprine have shown that in selected patients combination therapy may be superior to UDCA monotherapy. PSC is treated successfully with UDCA and endoscopic dilatation of the bile duct strictures. Treatment of extrahepatic manifestations of cholestatic liver disease such as pruritus, fatigue, osteoporosis and steatorrhea can be problematic and time-consuming.

Topics: Azathioprine; Celiac Disease; Cholagogues and Choleretics; Cholangitis, Sclerosing; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Liver Cirrhosis, Biliary; Osteoporosis; Prednisolone; Pruritus; Tacrolimus; Ursodeoxycholic Acid

We present a pediatric case of recurrent optic neuritis, celiac disease, partial IgA and IgG3 deficiency in the context of anti-aquaporin-4 auto-immunity and familial IgA deficiency with celiac disease. Treatment with tacrolimus was successful in preventing disease relapses. This case stresses the relevance of central nervous system anti-aquaporin-4 auto-immunity in a broader context of immune dysregulation and neuro-immunology.

Topics: Autoantibodies; Celiac Disease; Child; Dysgammaglobulinemia; Female; Humans; Immunoglobulin G; Immunosuppressive Agents; Neuromyelitis Optica; Optic Neuritis; Tacrolimus