Teprotumumab-Induced Ulcerative Colitis: A Case Report and Review of the Literature

Background:
Teprotumumab, an IGF-1 receptor antagonist, is primarily used for the treatment of thyroid eye disease. While its efficacy in reducing the severity of this condition is well-documented, there are emerging reports of gastrointestinal side effects, including the potential induction of inflammatory bowel diseases (IBD) such as ulcerative colitis (UC). This case report aims to present a rare instance of teprotumumab-induced UC.
Methods:
A 39-year-old female patient with a history of Graves’ disease s/p thyroidectomy, hypothyroidism, thyroid eye disease, lupus anticoagulant disorder, pulmonary embolism, was treated with teprotumumab. After 2 infusion doses of Teprotumumab, the patient developed symptoms of bloody diarrhea, abdominal pain, vomiting, weight loss. Colonoscopy revealed diffuse severe pan-colitis. The terminal ileum appeared normal. Pathology revealed active colitis with cryptitis, rare crypt abscesses, and crypt architectural distortion throughout the colon. The patient received a course of steroids with excellent clinical response. Follow-up colonoscopy revealed mild pan-colitis, significantly improved when compared to prior. Pathology revealed mild to moderate active colitis, and evidence of chronicity with architectural distortion, and prominent basal lymphoplasmacytosis. The patient was started on mesalamines achieving clinical remission. The temporal association between teprotumumab administration and the onset of symptoms strongly suggests a case drug-induced ulcerative colitis.
Results:
This case highlights the need for awareness of teprotumumab as a potential trigger for ulcerative colitis. Currently, there are only 2 published case reports on teprotumumab-induced ulcerative colitis. Both cases occurring in female patients who had received at least 5 infusions of teprotumumab for thyroid eye disease. The exact mechanism by which teprotumumab may induce UC is unclear. Teprotumumab is a relatively new drug, approved for thyroid eye disease in 2020 by the FDA. There are relevant publications on the safety of teprotumumab in treated thyroid eye disease, though no reports of ulcerative colitis were noted. Clinicians should be vigilant for gastrointestinal symptoms in patients receiving teprotumumab, and a thorough evaluation should be conducted if symptoms arise.
Conclusions:
Teprotumumab, while effective for treating thyroid eye disease, may have serious gastrointestinal side effects, including the induction of ulcerative colitis. Early recognition and appropriate management are crucial for mitigating the adverse effects.