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Ixekizumab is one of the three biologic agents including Secukinumab and Brodalumab that targets the Interleukin-17 (IL-17) pathway to reduce inflammation in psoriasis and ankylosing spondylitis. In this report we present the case of 42-year-old woman, who was diagnosed with psoriasis and psoriatic arthritis. One week after first administration of Ixekizumab, she developed diffuse abdominal pain, bloody diarrhea (7-8 stools/day) and fever. Following imaging (colonoscopy, computed tomography) and laboratory investigations, she was diagnosed with acute severe ulcerative colitis complicated with toxic megacolon. The medical treatment (first corticotherapy, then infliximab) has failed and the patient needed emergency colectomy. Based on the immunological mechanisms and the observation from other studies, Ixekizumab should be considered an etiology for new-onset inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Background & Aims: Both inflammatory bowel diseases (IBD) and ankylosing spondylitis (AS) can be considered chronic immune disorders sharing common etiopathogenetic mechanisms. Changes in the composition of the intestinal microbiota, which can lead to an abnormal mucosal response, could be the missing link between these two diseases. Our study evaluate the composition of intestinal microbiota and to characterize gut dysbiosis in patients with IBD and AS. Methods: We conducted a prospective case-control study that enrolled 124 patients [20 Crohn's disease (CD), 27 ulcerative colitis (UC), 28 AS, 17 IBD + AS and 32 controls). Intestinal microbiota analysis was performed by real-time polymerase chain reaction in stool samples. Results: The total quantity of bacteria was decreased in all investigated groups compared to the control group. In studied groups, we noticed an increased percentage of Bacteroides and Escherichia coli (E.coli) and a decreased percentage of Clostridium coccoides, Clostridium leptum, and Faecalibacterium prausnitzii compared to the control group. The percentages of Bifidobacterium (p=0.010) as well as Lactobacillus group (p=0.023) were higher in the L3 form of CD patients. In the E2 form of UC, the quantity of Bacteroides was much higher compared to the E3 form (p=0.004). In AS patients, significant correlations were observed only for the Bifidobacterium species, significantly increased in the axial form compared to peripheral disease (p=0.035). Statistically significant correlations were demonstrated between the Crohn Disease Activity Index score and the total bacterial group (p=0.023, r=-0.507), respectively Bacteroides (p=0.021, r=-0.511) and between the Mayo score and Lactobacillus (p=0.001), respectively E. coli (p=0.001). In IBD + AS group, the Crohn Disease Activity Index score was inversely correlated with the total bacterial group (p=0.010) and directly correlated with Lactobacillus (p=0.047). Conclusions: Intestinal dysbiosis is associated with both IBD and AS. In the association of IBD with AS, dysbiosis is intermediate, but it is associated with the more severe articular disease. Bifidobacterium and Lactobacillus (commonly used as probiotics!) were found to be increased in the association between active IBD and active AS. Further studies are needed to understand how dysbiosis regulates the gut immune system and contributes to intestinal and articular inflammation. [ABSTRACT FROM AUTHOR]

Objectives. Inflammatory bowel disease (IBD) are part of a pathology that has an ascending incidence both in Romania and around the world. It is well known that intestinal inflammation in IBD is not limited to the intestinal epithelium. Sometimes, extraintestinal manifestations (EIM) may have a more severe clinical expression than the intestinal disorder or may even encourage an increased morbidity. The research motivation focused on the development of specific clinical and epidemiological data for patients diagnosed with IBD who associate EIM. Material and methods. We performed a retrospective study including 517 patients with intestinal inflammation (Crohn disease - CD, ulcerative colitis - UC or undifferentiated colitis - NC) diagnosed during 1975-2016 in the N-E region of Romania. All the cases were extracted from the national database (IBD Prospect). Results. In our study the prevalence of UC versus CD cases prevailed. There were 368 cases (71.2%) of UC, 135 cases (26.1%) of CD and 10 cases of NC (1.9%). The prevalence of EIM in IBD patients in N-E Romania was 9,9% which was quite low. In the study group, EIMs occurred with a higher frequency in patients diagnosed with CD compared to UC. Thus, of the 51 cases of IBD and EIM, 27 (52.9%) belonged to the CD's phenotype and 24 cases (47.1%) of the UC's phenotype. Discussions. Both patients with CD and UC experienced a greater risk than the rest of patients for developing EIM. The most frequent EIMs were highlighted at the level of musculoskeletal system. Among EIM, there were 38 cases (74,5%) with articular manifestations (of which 26 had peripheral manifestations - arthritis, 12 cases developed axial manifestations - sacroiliitis/ankylosing spondylitis - SI/AS). Also, cases with multiple EIM had at least one articular manifestation. Conclusions. Our results sustain, once again, the fact that inflammation in IBD is not limited at the level of gastrointestinal tract. The presence of EIM, especially joint involvement, is a certainty validated by the results of many clinical trials. [ABSTRACT FROM AUTHOR]