Clofazimine enteropathy: a case of pigmentation of the whole small intestine caused by clofazimine

Clofazimine is mainly used for the treatment of neoplastic leprosy, and can also be used in combination with other anti-tuberculosis drugs to treat multidrug-resistant tuberculosis.

As is well known, clofazimine can within weeks cause skin pigmentation in 75% to 100% of patients, or, uncommonly, ichthyosis [11]. One of the most serious gastrointestinal side effects of clofazimine is deposition of black-purple crystals in the small bowel lamina propria, which leads to hyperpigmentation in the intestines. This most serious side effect of clofazimine, although rare, can result in severe or even fatal enteropathy [22]. We report a case of intestinal injury caused by clofazimine. After timely diagnosis and cessation of medication, the patient’s condition has significantly improved.

Our 32-year-old patient with drug-resistant tuberculosis developed abdominal pain after receiving anti-tuberculosis treatment with pyrazinamide, clofazimine, levofloxacin, and iminicotinamide for 16 months. Physical examination revealed that the skin on his back was reddish brown ([Fig. 1Fig. 1]), and the anterior tibial skin of both his lower limbs showed fish-scale-like changes ([Fig. 2Fig. 2]). Colonoscopy showed melanosis in the terminal ileum. The pathological report stated that tissue cells could be seen in the lesion area, and crystal-like substances could be seen inside ([Fig. 3Fig. 3]). Capsule endoscopy showed continuous pigmentation of the jejunum and ileum, with pigmentation of the jejunum being prominent ([Video 1Video 1]).

Fig. 1 Fig. 1 Clofazimine caused reddish-brown pigmentation of the skin on the back of a patient with intestinal injury.

Fig. 2 Fig. 2 Clofazimine caused fish-scale-like changes (ichthyosis) in the skin of both lower limbs in a patient with intestinal injury.

Fig. 3 Fig. 3 The pathological report on the biopsy of the distal segment of the ileum identified moderate chronic inflammation of the mucosa, with infiltration of lymphocytes, plasma cells, and scattered eosinophils. Tissue cells can be seen in the lesion area, and crystal-like substances can be seen inside.

Continuous pigmentation of the jejunum and ileum, with pigmentation of the jejunum being prominent.Video 1Video 1

Clofazimine treatment was stopped, and within 5 months the patient’s abdominal pain disappeared and the pigmentation and fish-scale-like changes in the back and lower limbs decreased.

Endoscopy_UCTN_Code_CCL_1AB_2AH_3AB

Conflict of Interest

The authors declare that they have no conflict of interest.

Acknowledgement

First of all, I would like to give my heartfelt thanks to all the people who have ever helped me in this paper. I am also extremely grateful to all my friends who have kindly provided me assistance and companionship in the course of preparing this paper. In addition, many thanks go to my family for their unfailing love and unwavering support. Finally, I am really grateful to all those who devote much time to reading this thesis and give me much advice, which will benefit me in my later study.

• References

• 1 Lawrence J, Brandt MD. An unusual cause of small-intestine mucosal pigmentation. Gastrointest Endosc 2011; 73: 1285-1286
• 2 Arbiser JL, Moschella SL. Clofazimine: a review of its medical uses and mechanisms of action. J Am Acad Dermatol 1995; 32: 241-247

Publication History

Article published online:
03 July 2024