腎癌術後多発性骨転移に対しIL-2療法を施行中,潰瘍性大腸炎様所見を伴う消化器症状を呈した1例  [in Japanese] A CASE OF DRUG-INDUCED COLITIS LIKE ULCERATIVE COLITIS DURING IL-2 THERAPY FOR MULTIPLE BONE METASTASIS AFTER OPERATION OF KIDNEY CANCER  [in Japanese]

60歳,男性.左腎腫瘍(cT1bN0M0)に対し,後腹膜鏡補助下根治的腎摘除術を施行した.腎癌,grade3,pT1bであった.その後,骨転移が出現し,IFN-γ投与,放射線治療を施行したが,PDのため,IL-2 70万単位/day週5回投与を開始した.投与28日目より下腹部痛・水様性下痢が出現した.検査所見上,著明に好酸球が増多していた.IL-2の関与を疑い,投与を中止したが改善見られないため,消化器内科を受診し,大腸内視鏡検査にて潰瘍性大腸炎様所見を呈する薬剤性腸炎と診断された.その後,IL-2投与中止を継続したところ,症状は改善傾向となった.IL-2が潰瘍性大腸炎の発症に関与するという報告は多く認められ,その投与により同様の所見を伴う薬剤性腸炎が発症したと考えられた.過去にこのような副作用報告はなく,IL-2と潰瘍性大腸炎との関連が示唆するものと考えられた.

A 60-year-old man underwent retroperitoneal laparoscopic nephrectomy for left renal tumor (cT1bN0M0). The histopathological examination revealed Kidney cancer grade3 pT1b. The following evaluations revealed multiple bone metastasis. The IFN-γ with radiation therapy were performed. However the disease was progressive. So IL-2 70 million units per day 5 times a week started. The patient started to complain lower abdominal pain and watery diarrhea from administration day 28th. Blood test showed eosinophilia. At this point side effect of IL-2 therapy was suspected, then IL-2 was discontinued. But abdominal symptoms had continued. Consulting with a digestive physician, he diagnose as drug-induced colitis like ulcerative colitis by colon endoscopy. The symptoms were gradually improved by an antiallergic agent on our assumption that eosinophilia was concerned in this colitis. Many articles have reported that IL-2 was associated with the clinical mechanism of ulcerative colitis, but there seems no reports about such complications before. This case could suggest IL-2 relates to ulcerative colitis.