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Inflammatory Bowel Disease Treatment and Non-melanoma Skin Cancer: A Case Report
Jacqueline F De Luca, MD, Yun Sun Lee, MD, and Douglas Johnson, MDcorresponding author
Public Health. 2012
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3497917/
Immunosuppressant medications for Inflammatory Bowel Disease can help with both symptoms and disease progression. However, like immunosuppressants used in transplant patients, they are now suspect of contributing to nonmelenoma skin cancer (NMSC). Presented is a case of a 57-year-old Jewish man with Crohn's Disease who was diagnosed with a total of 84 NMSCs. We hope to elucidate the risk of immunosuppressants, particularly the thiopurines, on the development of NMSC.
Our patient was treated with the thiopurine 6-MP for over 20 years, and was extensively affected with NMSC, necessitating numerous surgeries. In Long's study, persistent thiopurine use, defined as exceeding 365 days, was associated with more than a four-fold increase in risk for developing NMSC.2 Although the mortality from skin cancer in IBD patients is unknown thus far, it could very well follow the trends seen in transplant patients. More importantly, prolonged 6-MP is considered a significant risk factor for small bowel cancer for patients with CD (OR 10.8, CI 1.1–108.7).3 Our patient's prolonged course of 6-MP may be implicated in his premature death from metastatic adenocarcinoma of the small bowel. Further studies documenting longer-term exposure to immunosuppressives, in particular, the thiopurines, would be extremely beneficial for our understanding of the risks these medications pose.
Within the past year he discontinued 6-MP and began using mesalamine (Pentasa) and later adalimumab (Humira) hoping to attenuate the progression of NMSC, and continued to have monthly skin exams. Overall, he was hospitalized 16 times for his CD, but never required any intestinal resection. Unfortunately, in his most recent hospitalization he was diagnosed with metastatic adenocarcinoma of the small bowel, and passed away shortly after.
Jacqueline F De Luca, MD, Yun Sun Lee, MD, and Douglas Johnson, MDcorresponding author
Public Health. 2012
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3497917/
Immunosuppressant medications for Inflammatory Bowel Disease can help with both symptoms and disease progression. However, like immunosuppressants used in transplant patients, they are now suspect of contributing to nonmelenoma skin cancer (NMSC). Presented is a case of a 57-year-old Jewish man with Crohn's Disease who was diagnosed with a total of 84 NMSCs. We hope to elucidate the risk of immunosuppressants, particularly the thiopurines, on the development of NMSC.
Our patient was treated with the thiopurine 6-MP for over 20 years, and was extensively affected with NMSC, necessitating numerous surgeries. In Long's study, persistent thiopurine use, defined as exceeding 365 days, was associated with more than a four-fold increase in risk for developing NMSC.2 Although the mortality from skin cancer in IBD patients is unknown thus far, it could very well follow the trends seen in transplant patients. More importantly, prolonged 6-MP is considered a significant risk factor for small bowel cancer for patients with CD (OR 10.8, CI 1.1–108.7).3 Our patient's prolonged course of 6-MP may be implicated in his premature death from metastatic adenocarcinoma of the small bowel. Further studies documenting longer-term exposure to immunosuppressives, in particular, the thiopurines, would be extremely beneficial for our understanding of the risks these medications pose.
Within the past year he discontinued 6-MP and began using mesalamine (Pentasa) and later adalimumab (Humira) hoping to attenuate the progression of NMSC, and continued to have monthly skin exams. Overall, he was hospitalized 16 times for his CD, but never required any intestinal resection. Unfortunately, in his most recent hospitalization he was diagnosed with metastatic adenocarcinoma of the small bowel, and passed away shortly after.
