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Case Reports
. 2020 Jun 15;12(6):699-704.
doi: 10.4251/wjgo.v12.i6.699.

Immune checkpoint inhibitors induced colitis, stay vigilant: A case report

Suha Abu Khalaf  1 , Abdulmajeed Albarrak  2 , Mohamad Yousef  3 , Veysel Tahan  3
Affiliations
Case Reports

Immune checkpoint inhibitors induced colitis, stay vigilant: A case report

Suha Abu Khalaf et al. World J Gastrointest Oncol. .

Abstract

Background: Colitis is one of the immune-related side effects of immunotherapy. Usually, such type of side effect was reported to develop within a few weeks of treatment initiation, our case started within a few days.

Case summary: We present a case of a 37-year-old gentleman with bright red loose stools, abdominal pain, and tenesmus. A diagnosis of colitis was made based on endoscopic and histologic findings. Treatment was thereafter continued with oral steroids and discontinuation of the immunotherapy medications. Symptoms resolved after starting the treatment and the patient continued to be symptom-free on subsequent follow-up. The unique about this case report is that the patient developed bloody diarrhea within five days of the 1st immunotherapy cycle, and the patient was on combined ipilimumab and nivolumab.

Conclusion: Immunotherapy related complications might occur within days from being on immunotherapy; we need more research to open the way for future pathological and clinical research to further understand the pathophysiology behind it.

Keywords: Case report; Colitis; Hepatitis; Immunotherapy; Ipilimumab; Melanoma.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Endoscopic image of our patient who developed bloody diarrhea within five days of starting immunotherapy, the picture shows his transverse colon which was affected by grade IV severe pancolitis given diffuse erythema, inflammation, ulcers, and some patchy membrane at the proximal colon. Terminal ileum was examined, and it was unremarkable (no picture was included).
Figure 2
Figure 2
Colon mucosa biopsies stained with hematoxylin and eosin showing neutrophilic inflammation with cryptitis and crypt abscess as well as mucin depletion. A: Low power view 10 × highlighting distorted glands; B and C: Medium power view 20 ×, crypt abscess (orange arrow in B) and diffuse inflammation in the background.
See this image and copyright information in PMC

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