Is Tocilizumab A Risk Factor for Lower Gastrointestinal Perforations? Isolated Cecal Necrosis: A Rare Case Report

Elli üç yaşında kadın hasta, bilinen romatoid artrit ile hipertansiyon tanıları olup karın ağrısı ve kusma şikayetiyle acil servise başvurdu. Son 5 aydır tocilizumab (TCZ) kullanımı mevcuttu. Fizik muayene akut batın ile uyumlu idi. Yapılan abdomen bilgisayar tomografisinde çıkan kolonda 3 cm’lik alanda duvar kalınlık artışı ve çevresinde belirgin enflamasyon mevcuttu. Hasta acil operasyona alındı. Çekumda 6x8 cm’lik alanda nekroz izlendi. Hastaya sağ hemikolektomi ve ileokolostomi uygulandı. Postoperatif 8. günde sorunsuz taburcu edildi. Postoperatif spesimen patolojisinde normal mukozal duvarlardan keskin şekilde ayrılan mukozal nekroz izlendi. TCZ gibi yeni kullanılmaya başlanan ilaçların yan etki profilleri henüz netleşmemekle birlikte olgu takdimleri ile buna katkı sağlanmaktadır. Anahtar Kelimeler: İskemik kolit, nekroz, tocilizumab Isolated cecal necrosis is a rare seen clinical condition. A 53-year-old woman with a history of rheumatoid arthritis and hypertension presented to the emergency room with complaints of abdominal pain and vomiting that persists for two days. She had been using tocilizumab (TCZ) for the last 5 months. Physical examination was compatible with acute abdomen. Abdomen computerized tomography showed a wall thickness approximately 3 cm on ascending colon that surrounded with significant inflammation. She was operated with a presumptive diagnosis of acute abdomen. During laparotomy, isolated necrosis with 10x9 cm diameter was observed in the cecum. A right hemicolectomy and ileocolostomy was performed. She was discharged on the 8th postoperative day. Postoperative specimen pathology was showed mucosal necrosis sharply separated from normal mucosal walls. Although the side effect profile of newly used drugs such as TCZ is not clear yet; with larger case reports and series can be contributed.