PDF(Pubmed)
Abstract：
The cornerstone of inflammatory bowel disease (IBD) treatment is immunomodulators. IBD patients are at increased risk of intestinal and extraintestinal malignancy. Ustekinumab is a fully humanized monoclonal anti-IL12/23 antibody with a good safety profile. Malignancies of breast, colon, head and neck, kidney, prostate, thyroid, and non-melanoma skin cancer have been reported among patients who received ustekinumab. We report the case of a 42-year-old Crohn\'s patient on long-term treatment with ustekinumab, who developed achromatic malignant melanoma. Crohn\'s was diagnosed at the age of 15, with upper and lower gastrointestinal involvement and was initially treated with azathioprine (2mg/kg for 4 years) and infliximab (5mg/kg for 6 weeks). Due to ileal obstruction, the patient underwent stricturoplasty and received adalimumab (40mg every other week) for two years. He then discontinued therapy and a year later underwent right hemicolectomy. Adalimumab was reinstituted (40mg every other week) and the patient remained in clinical remission for two years. His overall exposure to adalimumab was four years. Ustekinumab was initiated due to a relapse and after 3 years, an incident of scalp itching led to the diagnosis metastatic achromatic malignant melanoma bearing BRAF V600E mutation. He received targeted therapy with an initial good response. We aim to point out the risk of dermatologic malignancy in IBD patients on long-term immunosuppression and the lifelong and meticulous evaluation that is required.
摘要：
炎症性肠病(IBD)治疗的基石是免疫调节剂。IBD患者肠道和肠外恶性肿瘤的风险增加。Ustekinumab是一种完全人源化的单克隆抗IL12/23抗体，具有良好的安全性。乳腺恶性肿瘤,结肠,头部和颈部,肾,前列腺,甲状腺，在接受ustekinumab治疗的患者中,有非黑色素瘤皮肤癌的报道.我们报告了一个42岁的克罗恩患者长期接受ustekinumab治疗的病例，患上了消色差恶性黑色素瘤.克罗恩病在15岁时被诊断为上消化道和下消化道受累，最初接受硫唑嘌呤(2mg/kg，持续4年)和英夫利昔单抗(5mg/kg，持续6周)治疗。由于回肠阻塞,患者接受了狭窄成形术,并接受了阿达木单抗(40mg,每隔一周)治疗2年.然后他停止了治疗，一年后接受了右半结肠切除术。阿达木单抗被重新使用（每周40mg），患者保持临床缓解两年。他对阿达木单抗的总暴露时间为四年。Ustekinumab是由于复发而开始的，3年后，头皮瘙痒事件导致诊断为带有BRAFV600E突变的转移性消色差恶性黑色素瘤。他接受靶向治疗，初步反应良好。我们的目的是指出长期免疫抑制的IBD患者发生皮肤恶性肿瘤的风险，以及需要的终身和细致的评估。
