Immune Checkpoint Inhibitor-Induced Colitis Successfully Followed up by Ultrasonography

Abstract

Nivolumab is an immune checkpoint inhibitor (ICI), which is used for treatment of advanced malignancies. Diarrhea is a typical adverse effect of ICIs. Several endoscopic features of ICI-related colitis have been reported. Herein, we reported a case of ICI-related colitis, with successful follow-up using ultrasonography (US). A 54-year-old woman, diagnosed with renal cell carcinoma, underwent radical nephrectomy. Multiple liver and bone metastases appeared 6 months after surgery. She was prescribed sunitinib, which was discontinued, because of severe diarrhea. She was prescribed nivolumab after 1 week. However, she was hospitalized 9 days later, due to fever and diarrhea. US showed diffuse wall thickening from the cecum to the rectum. The wall layer structures were preserved, and thickening was observed mainly in the submucosa, but not in the mucosa, without a decrease in the echo level. Subsequently, sigmoidoscopy was performed. Severe edema was observed in the mucosa, without any erosion and granularity. She was clinically diagnosed with ICI-related colitis, and steroid therapy was administered. One week after steroid therapy, the diarrhea improved, and the earlier findings showed marked improvement on US. After another week of reduced steroid dose, US revealed further improvement, and she was discharged. Keywords Immune checkpoint inhibitor. Nivolumab. Immune-related adverse effect. Colitis. Ultrasonography This article is part of the Topical Collection on Imaging

Characteristics and usefulness of transabdominal ultrasonography in immune-mediated colitis

“…[36][37][38][39][40][41][42][43][44][45] To the best of our knowledge, there has been only 1 case report in which intestinal US was used in IMC. 48 Therefore, our study analyzed the features of US findings in IMC, as well as their correlation with endoscopic findings, CTCAE grade, and CRP. The US findings showed a correlation between UCEIS and CTCAE.…”

“…US has been found useful in CD, UC, and graft-versus-host disease enterocolitis, and its findings correlated with those of endoscopy [ 36 - 45 ]. To the best of our knowledge, there has been only 1 case report in which intestinal US was used in IMC [ 48 ]. Therefore, our study analyzed the features of US findings in IMC, as well as their correlation with endoscopic findings, CTCAE grade, and CRP.…”

A case of immune checkpoint inhibitor‐associated gastroenteritis detected by ultrasonography

“…Our patient received pembrolizumab monotherapy as a first‐line treatment, which was discontinued after gastroenteritis onset. However, several cases of gastrointestinal perforation under anti‐PD‐1 therapy have been described 13 Although multiple cases of ICI‐related colitis have been reported, 14‐16 reports on ICI‐related gastritis are rare. There are two sets of guidelines regarding the treatment of colitis; however, there are no guidelines for the treatment of ICI‐related gastritis 17,18 …”