[Extramedullary plasmacytoma of the colon]. / Plasmocitoma extramedular de localización colónica.

We report the case of a 68 year-old man in whom a tumour of the colon was identified by colonoscopy, during diagnostic studies for lower gastrointestinal bleeding as an outpatient. Histological examination showed clonal proliferation of plasma cells IgG-K. No other location was affected (including bone marrow). Diagnosis of plasmacytoma of the colon was made. We have carried out a review of the literature in relation to this unusual disorder.

Plasmocitoma extramedular de localización colónica / Extramedullary plasmacytoma of the colon

Se presenta el caso de un varón de 68 años de edad, a quien durante el estudio ambulatorio de rectorragia de características distales se identifica una tumoración colónica secundaria a una proliferación clonal de células plasmáticas IgG-K. En el estudio de extensión no se demostró ninguna afectación medular ni de otros órganos, por lo que se diagnostica un plasmocitoma extramedular de localización colónica. Llevamos a cabo una revisión de la literatura médica en relación con esta infrecuente enfermedad

We report the case of a 68 year-old man in whom a tumour of the colon was identified by colonoscopy, during diagnostic studies for lower gastrointestinal bleeding as an oupatient. Histological examination showed clonal proliferation of plasma cells IgG-K. No other location was affected (including bone marrow). Diagnosis of plasmacytoma of the colon was made. We have carried out a review of the literature in relation to this unusual disorder

[Tacrolimus in the treatment of refractory moderate-to-severe inflammatory bowel disease]. / Tacrolimus en el tratamiento de la enfermedad inflamatoria intestinal refractaria moderada-grave.

INTRODUCTION: The primary endpoint of this study was to evaluate the efficacy of oral tacrolimus in patients with active moderate-to-severe luminal IBD, mainly those refractory to steroids. Secondary endpoints were surgery requirements during follow-up, the percentage of patients achieving steroid withdrawal, and treatment safety. PATIENTS AND METHOD: Nineteen patients were included. The main indication for tacrolimus therapy was steroid resistance. The mean duration of treatment was 11 (range 3- 13) and 15 (range 4-44) months in patients with UC and CD, respectively. Remission was evaluated at weeks 4, 8 and 24 from the start of treatment, using the Harvey-Bradshaw index and the Truelove-Witts criteria for CD and UC patients, respectively, and acute- phase reactants (Serum erythrocyte sedimentation rate and C-reactive protein). Steroid withdrawal, need for surgery, and previous and concomitant medication were also evaluated. RESULTS: Overall, 47%, 66% and 41% of the patients were in complete remission at weeks 4, 8 and 24, respectively. Steroid withdrawal was achieved in 50% of the patients. Among patients who could not undergo complete steroid withdrawal, steroid therapy was reduced to a mean prednisone dose of 12.5 mg /day (range 10-15 mg). Surgery was required in 16% (mean follow-up of 38 months). Adverse effects occurred in 63% patients, who improved with dose reduction; none of the patients required tacrolimus withdrawal. CONCLUSIONS: Oral tacrolimus could be a safe, effective and useful option in patients with refractory IBD.

Tacrolimus en el tratamiento de la enfermedad inflamatoria intestinal refractaria moderada-grave / Tacrolimus in the treatment of refractory moderate-to-severe inflammatory bowel disease

Introducción: El objetivo principal de este estudio ha sido evaluar la eficacia de tacrolimus oral en la enfermedad inflamatoria intestinal (EII) moderada-grave luminal, principalmente corticorrefractaria. Los objetivos secundarios fueron evaluar los requerimientos de cirugía en el período de seguimiento, el porcentaje de pacientes en que se consiguió la suspensión de la terapia corticoidea y analizar la seguridad del tratamiento. Pacientes y método: Se incluyó a 19 pacientes. La indicación mayoritaria fue la corticorrefractariedad. La duración media del tratamiento con tacrolimus fue de 11 meses (rango, 3-13) y 15 meses (rango, 4-44) en pacientes con colitis ulcerosa y enfermedad de Crohn, respectivamente. Para evaluar los resultados se consideró el porcentaje de pacientes que se encontraban en remisión a las 4, 8 y 24 semanas desde el inicio del tratamiento, utilizando para ello índices de actividad clínicos (Truelove modificado y Harvey-Bradshaw) apoyados por reactantes de fase aguda (PCR Y VSG). También se analizó la posibilidad de suspensión de corticoides y la necesidad de cirugía. A su vez, se consideraron las medicaciones previas y concomitantes que habían sido utilizadas. Resultados: De forma global, un 47, un 66 y un 41% de los pacientes presentan remisión a las semanas 4, 8 y 24, respectivamente. Se consiguió retirar los esteroides en un 50% de los pacientes. Entre los pacientes a los que no se pudo retirar por completo el tratamiento esteroideo, se pudo reducir la dosificación con una media de 12,5 mg de prednisona/día (rango, 10-15). Precisó cirugía el 16% de los pacientes en un seguimiento medio de 38 meses. Presentó efectos adversos el 63% de los pacientes, que no obligaron a la suspensión del tratamiento en ningún caso, y mejoraron con la reducción de la dosis. Conclusiones: Tacrolimus oral puede ser una opción útil, de fácil manejo, efectiva y segura en los pacientes con EII refractaria

Introduction: The primary endpoint of this study was to evaluate the efficacy of oral tacrolimus in patients with active moderate-to-severe luminal IBD, mainly those refractory to steroids. Secondary endpoints were surgery requirements during follow-up, the percentage of patients achieving steroid withdrawal, and treatment safety. Patients and Method: Nineteen patients were included. The main indication for tacrolimus therapy was steroid resistance. The mean duration of treatment was 11 (range 3- 13) and 15 (range 4-44) months in patients with UC and CD, respectively. Remission was evaluated at weeks 4, 8 and 24 from the start of treatment, using the Harvey-Bradshaw index and the Truelove-Witts criteria for CD and UC patients, respectively, and acute- phase reactants (Serum erythrocyte sedimentation rate and C-reactive protein). Steroid withdrawal, need for surgery, and previous and concomitant medication were also evaluated. Results: Overall, 47%, 66% and 41% of the patients were in complete remission at weeks 4, 8 and 24, respectively. Steroid withdrawal was achieved in 50% of the patients. Among patients who could not undergo complete steroid withdrawal, steroid therapy was reduced to a mean prednisone dose of 12.5 mg /day (range 10-15 mg). Surgery was required in 16% (mean follow-up of 38 months). Adverse effects occurred in 63% patients, who improved with dose reduction; none of the patients required tacrolimus withdrawal. Conclusions: Oral tacrolimus could be a safe, effective and useful option in patients with refractory IBD