P022 CROHN'S DISEASE AND ACUTE B LYMPHOBLASTIC LEUKEMIA – COINCIDENCE OR ASSOCIATION?. (18th January 2018)

• Record Type: Journal Article
• Authors: Castela, Joana; Rosa, Isadora; Nunes, Albertina; Pereira, António Dias
• Is Part Of: Inflammatory bowel diseases. Volume 24(2018)Supplement 1
• Page Start: S9
• Page End: S9
• Publication Date: 2018-01-18
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izy019.025
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: A 34-year-old male with Crohn's disease (CD) (A2-L3-B3) and bad prognostic criteria at diagnosis, was treated with a "top down" strategy with infliximab and azathioprine, with clinical remission but focal endoscopic activity. After 3 years, a toxidermic reaction to infliximab led to its suspension. On azathioprine monotherapy for 6 months, a severe exacerbation occurred and adalimumab was added. In 2015 the patient presented with anorexia, asthenia, myalgia, fever and nasal congestion. Blood tests revealed bicytopenia, acute kidney injury, hyperuricemia and high LDH. The patient was hospitalized and immunosuppressive therapy was suspended. Blood smear showed blast cells, with bone marrow aspirate flow cytometry analysis confirming an acute B lymphoblastic leukemia (FISH: t(14, 18)). He underwent 7 cycles of chemotherapy, and is currently awaiting autologous stem cell transplantation. Despite several infectious complications the patient is stable and CD is in clinical remission. CD is not often associated with acute leukemia, and most reported cases refer to the myeloid type. A possible association between these 2 pathologies may be multifactorial, involving therapy adverse effects, immune system disturbances and genetic predisposition. Case analysis may help to increase clinical awareness and to gain better understanding of treatment response and prognosis for this combination of diseases.