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Case Reports
. 2024;16(14-15):943-948.
doi: 10.1080/1750743X.2024.2386234. Epub 2024 Aug 19.

Fulminant immune-related colitis after dual checkpoint inhibitor therapy: case report

Robert Lukin  1 , Aaron Ciner  2
Affiliations
Case Reports

Fulminant immune-related colitis after dual checkpoint inhibitor therapy: case report

Robert Lukin et al. Immunotherapy. 2024.

Abstract

Aim: Immune-related (IR) colitis is a potentially life-threatening complication of checkpoint inhibitors. Its presentation often includes diarrhea, abdominal pain and rectal bleeding and the median time to onset is 6-10 weeks post initiation of immunotherapy.Case study: We report an unusual case of fulminant IR-colitis beginning 3 days after the first dose of dual checkpoint blockade. IR-colitis was refractory to high-dose corticosteroids and was further complicated by sigmoid diverticulum perforation.Conclusion: Early-onset IR-colitis can occur, particularly in the context of combined anti-PD1 and anti-CTLA4 blockade, and clinicians should maintain a high-index of suspicion even when timing of symptom onset is atypical. Further research is needed to elucidate risk factors for early-onset IR-colitis.

Keywords: dual checkpoint blockade; fulminant immune-mediated colitis; hepatocellular carcinoma; immunotherapy.

Plain language summary

We report an unusual case of immune-related (IR)-colitis that occurred just 3 days after receiving treatment for liver cancer with a class of drug called immunotherapy. Immunotherapy works by enabling our own immune system to attack cancer cells that should not be present in our body. One unwanted side effect of this therapy is that our immune system can attack normal tissue and organs. IR colitis is when immunotherapy leads the immune system to attack the large intestine, and often presents with abdominal pain, diarrhea and blood in the stool. This side effect typically occurs 6-10 weeks following start of immunotherapy. This case is unusual because of the very early onset of IR colitis. The patient reported herein had a severe case of IR colitis that required the surgical team to emergently remove part of his large intestine. This case demonstrates that IR colitis can happen significantly earlier than the typical time course, highlighting the need for clinicians and patients alike to maintain a high index of suspicion for this potentially life-threatening toxicity. Future studies should aim to identify potential risk factors for early-onset IR colitis.

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Conflict of interest statement

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, stock ownership or options and expert testimony.

Figures

Figure 1.
Figure 1.
Colonoscopy images showing edematous, congested and erythematous mucosa with superficial erosions throughout the colon concerning for IR-colitis.
Figure 2.
Figure 2.
This flow-chart demonstrates the patient's clinical course after receiving cycle 1 of dual checkpoint blockade.
See this image and copyright information in PMC

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