A 58-year-old male diagnosed with CLL type B with no evidence of disease progression that five years later presented growth and progression of inguinal, axial and cervical lymphadenopathy.
She received 6 cycles of rituximab (375 mg/m2 IV of onset, 500 mg/m2 IV of successive doses), fludarabine (25 mg/m2 IV) and cyclophosphamide (250 mg/m2 persistent disease).
Because of these characteristics, he started treatment with idelalisib (150 mg/12 hours v.o.) combined with rituximab (375 mg/m2 IV initial dose, subsequent doses of 500 mg/m2 IV).
Three months after the start of treatment, the patient evolved with 7-8 stools per day without pathological products of abdominal pain, but without continuous mesogastric nausea or vomiting associated with deposition.
The results of the coprocultives and hemocultives performed are negative.
Abdominal CT showed increased caliber ascending colon loops, thickening of the wall and enhancement compatible with the diagnosis of inflammatory colitis.
Treatment with idelalisib was suspended and serum therapy and analgesia were initiated.
Elevated ciprofloxacin with peak and general binding; therefore, ciprofloxacin (400 mg/12 h), sutitu y later due to urticaria/ febrile deterioration (4 g/6 h IV), was added.
As complications derived from admission, the patient develops pneumothorax during central venous line cannulation and, for two days in the ICU, presents quantitative diarrhea with electrolyte disturbances requiring volume replacement and electrolyte replacement.
One week after antibiotic treatment, renal function was altered and, due to clinical deterioration at the digestive level, she received corticoids (budesonide 9 mg/24 h oral, which is sustained by methylprednisolone 60/6 mg).
After seven days with systemic corticosteroids, there was an improvement in abdominal pain (resolving to disappear), with a decrease in the number and amount of stools and recovery of general condition.
At hospital discharge, prednisone (50 mg/24 h PO) was maintained until complete resolution of symptoms.
Two months after hospital discharge, treatment with idelalisib (100 mg/12 h PO) resumed and two months later the patient was readmitted for a new episode of colitis, although milder than the first.
Idelalisib was definitively suspended and supportive serum therapy was initiated.
After 24 h, the patient continued with diarrhea profuse (10 daily liquid stools) and feverish peak. Antibiotic therapy was initiated with levofloxacin (500 mg/24 h IV), which was replaced by meropenem (1 g/8h).
Coprocultives and hemocultives were negative.
After one week with antibiotic treatment, treatment with systemic corticosteroids was initiated at 1 mg/kg/day, showing improvement in the general condition, with a decrease in the number of stools after a given week of treatment with prednisone.
