• Sotaro Ozaka, Masahide Fukuda, Haruhiko Takahashi, Koshiro Tsutsumi, Masao Iwao, Yuka Hirashita, Kensuke Fukuda, Kazuhisa Okamoto, Mie Arakawa, Ryo Ogawa, Mizuki Endo, Kazuhiro Mizukami, Naganori Kamiyama, Takashi Kobayashi, Masaaki Kodama, and Kazunari Murakami.
• Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan.
• Medicine (Baltimore). 2023 Jun 23; 102 (25): e34118e34118.

RationaleTocilizumab, a humanized anti-interleukin-6 (IL-6) receptor monoclonal antibody, is used for the treatment of adult-onset Still disease (AOSD). Despite its efficacy in many clinical situations, concerns have been raised regarding intestinal mucosal injury in patients receiving tocilizumab.Patient ConcernsA 64-year-old woman with a history of AOSD was admitted to our hospital with hematochezia. She had AOSD for 15 years and underwent treatment with biweekly tocilizumab 9 months prior to admission. Colonoscopy revealed a large punched-out ulcer in the terminal ileum. On pathological evaluation, nonspecific enteritis with lymphocytes and eosinophils were seen. Based on the location and shape of the lesion, we suspected intestinal Behçet's disease. However, the ulcer reduced in size over time by discontinuation of tocilizumab without additional drug treatment, indicating that it was a drug-induced ulcer.DiagnosisThe patient was diagnosed with tocilizumab-induced small intestinal ulcer.InterventionsThe patient treated with the discontinuation of tocilizumab.OutcomesThe discontinuation of tocilizumab resulted in ulcer scarring. There was no recurrence of hematochezia.LessonsTocilizumab can cause deep ulcerative lesions in the terminal ileum, which may resemble intestinal Behçet's disease. It is important to continuously monitor abdominal symptoms during tocilizumab therapy and aggressively perform colonoscopy when hematochezia or abdominal pain is observed.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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