Year 2024 / Volume 116 / Number 12
Letter
Immuno-mediated colitis induced by nivolumab that mimics endoscopically and histologically an ulcerative colitis

701-702

DOI: 10.17235/reed.2024.10180/2023

Daniel Muíño Domínguez, Fernando Fernández Cadenas, María Helena González Sánchez, Marta García Calonge, Andrea Soria Montoya, Adolfo Suárez González,

Abstract
Immunotherapy has revolutionized the management of oncological pathology, demonstrating effectiveness in treating various cancers by stimulating the immune system against tumor cells. Among the immunotherapy drugs are programmed cell death protein 1 (PD-1) inhibitors, such as Nivolumab, which, by blocking this receptor on the surface of T lymphocytes, enhance the immune response. Despite their significant benefits, these agents present specific adverse effects on healthy tissues that need to be understood. One of these effects is immune-mediated colitis, a potentially serious gastrointestinal disorder that may require the permanent discontinuation of the drug. Although it can occur with various immunotherapy regimens, it occurs more frequently with anti-CTLA4 agents like Ipilimumab, with its incidence much lower with anti-PD1 agents. We present the case of a 62-year-old male diagnosed with metastatic clear cell renal carcinoma treated with radical nephrectomy and subsequent palliative systemic treatment with Nivolumab. After the third cycle of immunotherapy, he developed abdominal pain and diarrhea. Colonoscopy revealed continuous mucosal inflammation up to the cecum, erosions, exudates, and loss of the vascular pattern. Biopsies showed signs of active colitis, cryptic abscesses, and focal cryptitis, all consistent with a case of immuno-mediated colitis induced by Nivolumab that mimics, both endoscopically and histologically, the findings found in ulcerative colitis.
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References
1. Champiat S, Lambotte O, Barreau E, et al. Management of immune checkpoint blockade dysimmune toxicities: a collaborative position paper. Ann Oncol 2016; 27(4):559-74.
2. Luque AM, Ontanilla-Clavijo G, Leo E. Severe enterocolitis secondary to ipilimumab and nivolumab with an excellent response to a single dose of infliximab. Rev Esp Enferm Dig 2020; 112(11):889-890.
3. Yamauchi R, Araki T, Mitsuyama K, et al. The characteristics of nivolumab-induced colitis: an evaluation of three cases and a literature review. BMC Gastroenterol 2018; 31;18(1):135.
4. Cañete F, Mañosa M, Lobatón T, et al. Nivolumab-induced immune-mediated colitis: an ulcerative colitis look-alike-report of new cases and review of the literature. Int J Colorectal Dis 2019; 34(5):861-865.
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Citation tools
Muíño Domínguez D, Fernández Cadenas F, González Sánchez M, García Calonge M, Soria Montoya A, Suárez González A, et all. Immuno-mediated colitis induced by nivolumab that mimics endoscopically and histologically an ulcerative colitis. 10180/2023


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Publication history

Received: 17/12/2023

Accepted: 12/01/2024

Online First: 29/01/2024

Published: 13/12/2024

Article Online First time: 43 days

Article editing time: 362 days


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