Immune Checkpoint Inhibitor-Induced Acute Pancreatitis and Colitis

Abstract

Given the promising response of immune checkpoint inhibitors (ICPIs) in treating advanced malignancies, their use in clinical practice is on the rise. ICPIs are associated with a wide spectrum of immune-related adverse events (irAEs). The reported side effects of therapy can be severe enough to require interruption or withdrawal. We are presenting a case of a checkpoint inhibitor-induced acute pancreatitis and colitis, treated with high-dose steroids. This case highlights the need for all physicians to be aware of the different presentations of irAEs from checkpoint inhibitors to provide the correct diagnosis and management.

A case of antiprogrammed death‐ligand 1 antibody‐induced multisystem immune‐related adverse events with pancreatitis and steroid‐resistant sclerosing cholangitis

“…Further, the incidence of pancreatitis caused by antiprogrammed cell death 1 antibody is reported to be 1% in cases with lung cancer, 12 and there are also reports on its coexistence with colitis. [13][14][15] A case study 13 on the coexistence of sclerosing cholangitis and pancreatitis exists, similar to the present study, wherein endoscopic ultrasoundfine needle aspiration (EUS-FNA) showed CD8 + T lymphocyte infiltration in the liver and pancreatic tissues. Also, IgG4 levels were not elevated in the previous and present cases.…”

“…This result was also observed in previous studies of sclerosing cholangitis and pancreatitis. [13][14][15]23 Thus, irAE pancreatitis may have a good response to PSL, in contrast to cholangitis.…”

The Simultaneous Onset of Pancreatitis and Colitis as Immune-related Adverse Events in a Patient Receiving Nivolumab Treatment for Renal Cell Carcinoma

“…Although few reports regarding colitis and pancreatitis as irAEs in association with ICI treatment have been presented, especially for patients with a combination of both diseases, Pagen et al reported a case of pembrolizumab-induced acute pancreatitis combined with colitis ( 21 ). The location and pathophysiology of colitis were similar in the present case, and the timing of the development of enteritis and pancreatitis was also nearly the same.…”