Page 34 - BH-2-4

Brain & Heart Neurologic manifestations of IBD

releasing inflammatory cytokines that contribute to the colectomy, both of whom responded well to treatment with
disease’s pathogenesis. 34,35 pyridostigmine and prednisone.
In terms of clinical management, the treatment of CVT Although the simultaneous presence of these autoimmune
in patients with IBD is generally administered in adherence diseases in patients is rare, it is crucial to recognize that
to the standard protocols. Preferred treatments include symptoms such as ocular, bulbar, or limb impairments
low molecular weight heparin, intravenous heparin, and might be early indicators of MG in IBD patients, especially
Vitamin K antagonists. The ongoing debate about the use of following alterations in their immunosuppressive regimen.
corticosteroids in these patients revolves around their ability
to reduce procoagulant activity by mitigating inflammation. 3.4. Myositis
However, the administration of intravenous steroids has The occurrence of polymyositis, dermatomyositis, and
been associated with an increased risk of thromboembolism, localized forms of myositis in patients with IBD underscores
necessitating careful monitoring of IBD patients with a its systemic nature. These myopathic conditions, though
significant risk of thrombotic events. Such patients may rare, are significant due to their potential impact on
require short-term anticoagulant prophylaxis, especially morbidity and quality of life.
when treated with high doses of systemic steroids. 36
4. Polymyositis and dermatomyositis
3.3. MG
Polymyositis and dermatomyositis are autoimmune
MG has been observed in association with both UC diseases characterized by inflammation of the muscles, with
and CD, with this relationship seemingly rooted in the dermatomyositis also involving skin manifestations. The
aberrant function of T-lymphocytes and the production association between these conditions and IBD, particularly
of acetylcholine receptor antibodies due to autoimmune CD and UC, suggests a shared autoimmune or inflammatory
dysregulation. Furthermore, MG coexists with other pathway. Despite that, the exact prevalence is unknown,
autoimmune conditions such as alopecia, lichen planus, probably due to the rarity of these conditions. However,
vitiligo, and systemic lupus erythematosus. Notably, isolated occurrences of these disorders have been highlighted
thymus abnormalities, which are characteristic of MG, in case reports. The pathophysiological link between IBD
2
have also been linked with IBD, particularly through and these myopathies may involve shared immunological
the persistence of thymus function into later age in MG mechanisms. Inflammatory cytokines, which are elevated in
patients, which correlates with similar phenomena in UC. IBD, could potentially trigger or exacerbate the autoimmune
Comparative studies of T-cells from MG and UC patients responses seen in polymyositis and dermatomyositis. This
show a decreased ratio of suppressor (CD8+) to helper is supported by the observation that these conditions can
(CD4+) T-cells relative to healthy individuals. 37
flare with intestinal disease and may improve with treatment
The immunological connections between MG and IBD of bowel inflammation. Using a large population-based
are highlighted through clinical observations, such as the electronic health database from Israel, a recent retrospective
case reported by Finnie et al., where a female patient cohort study analyzed the association between IBD and
37
developed both MG and CD, further complicated by polymyositis/dermatomyositis and determined the prevalence
perineal abscesses and fistulas post-total colectomy. The of IBD in those with polymyositis/dermatomyositis by
patient’s MG, unresponsive to drug therapy, improved assessing data from 2085 polymyositis/dermatomyositis
after a thymectomy, which also positively influenced her patients and 10,193 matched controls. The findings suggest
40
CD. Conversely, Gower-Rousseau et al. documented a a statistically significant association between polymyositis/
38
case where UC and MG coexisted, and the MG symptoms dermatomyositis and IBD, with an increased prevalence of
regressed following proctocolectomy. IBD in patients with polymyositis/dermatomyositis, even after
MG can manifest in either ocular or generalized adjusting for variables such as age, gender, socioeconomic
forms, displaying symptoms such as paresis, dysphagia, status, and BMI. Patients with polymyositis/dermatomyositis
dysarthria, and fatigue. For instance, Foroozan and had 1.73-time higher odds of having IBD compared to
Sambursky described a 21-year-old male with UC and controls. Moreover, the presence of antinuclear antibodies
39
other complications, who exhibited MG symptoms such in polymyositis/dermatomyositis patients was identified as a
as binocular diplopia and ptosis, which resolved after significant predictor for the development of IBD.
treatments including plasmapheresis and medications
such as azathioprine and prednisone. Similarly, Gondim 5. Localized forms of myositis in IBD
et al. reported on two patients in a Brazilian IBD cohort Localized myositis in IBD presents as inflammation
40
who developed severe MG symptoms rapidly post- confined to specific muscle groups, leading to symptoms

Volume 2 Issue 4 (2024) 5 doi: 10.36922/bh.3486