Abstract
Purpose: Golimumab is a human IgG monoclonal antibody specific for human tumor necrosis factor alpha (TNF-α). Golimumab has been approved for use in rheumatological conditions; however, its use in inflammatory bowel disease (IBD) is still in clinical trials. We report a case of an exacerbation of ulcerative proctitis after starting on golimumab for ankylosing spondylitis (AS). A 25-year-old male with ulcerative proctitis was treated with topical mesalamine with symptoms resolution for 14 months. In January 2011, the patient started complaining of right hip and lower back pain. An X-ray revealed joint space narrowing and right sacroiliitis. Blood test for HLA B27 was positive. The patient was referred to rheumatologist for further management. He was started on golimumab for the treatment of AS in March 2011. One month later his joint and back pain improved markedly with golimumab treatment. Three months after being on golimumab, he presented with hematochezia associated with watery diarrhea and weight loss. Physical examination was unremarkable except for left lower quadrant tenderness. Colonoscopy revealed active ulcerative proctitis confirmed by biopsy. The dose of topical meselamine was increased to twice a day. The patient's symptoms partially improved after one month, however, some symptoms persisted. Golimumab therapy was stopped and adalimumab was started as treatment for intestinal and extra-intestinal manifestations of IBD. His symptoms improved markedly within a few weeks of golimumab cessation and initiation of adalimumab. Follow-up flexible sigmoidoscopy revealed resolution of proctitis. His proctitis is currently in remission; however, he still has minimal joint discomfort. To our knowledge, this is the fourth reported case in the English literature suggesting worsening of inflammatory bowel disease on golimumab. In conclusion, the use of golimumab for treating ankylosing spondylitis in patients with inflammatory bowel disease may exacerbate their intestinal disease.Table: No Caption available.
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