Proctitis ulcerosa refractaria: Tratamiento alternativo con enema de tacrólimus

espanolEl tratamiento de eleccion para proctitis ulcerosa se basa en farmacos derivados del acido 5-aminosali-cilico y corticoides. En pacientes con proctitis ulcerosa refractaria a estos farmacos existen diversas opciones terapeuticas incluyendo tiopurinas, anti-TNFα y otras alternativas menos estudiadas como inhibidores de calcineurina.Presentamos el caso de una mujer de 59 anos diagnosticada de proctitis ulcerosa refractaria al tra-tamiento convencional. Dada la delimitada afectacion y el perfil de efectos adversos de la terapia sistemica, se plantea la terapia topica con enemas de tacrolimus. La administracion de tacrolimus por via rectal permite actuar directamente en el lugar de la inflamacion, dis-minuyendo el riesgo de efectos adversos sistemicos.El uso de enema de tacrolimus ha permitido lo-grar la remision clinica y mantener la respuesta duran-te 19 meses, siendo una terapia bien tolerada. Podria ser una alternativa eficaz en pacientes con proctitis ulcerosa resistente en los que no este indicado iniciar una terapia sistemica. English5-aminosalicylates (5-ASA) and corticosteroids are the usual first-choice treatments for inducing ul-cerative proctitis remission. However, in those patients that do not respond to those treatments, additional therapies such as immunomodulators, TNFα antago-nists and some other potentially efficacious alternati-ves like calcineurin inhibitors can be administered.We report the case of a 59 year-old woman diag-nosed with treatment-resistant ulcerative proctitis. Due to the limited disease extent and the potential side effects of systemic therapy, we decided to apply a topical tacrolimus enema. The application of tacro-limus directly on the inflamed tissues could achieve a local effect and may minimize systemic side effects.Rectal tacrolimus administration was effective for inducing a clinical remission in this patient and be-sides, for maintaining its response during 19 months of treatment without presenting any safety issues. Rectal tacrolimus may be regarded as an alternative treatment for resistant ulcerative proctitis when syste-mic therapy is not indicated.