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Ulcerative colitis flare-up, enterocolitis and diarrhoea: case report An approximately 76-year-old man developed diarrhoea during treatment with axitinib. He also exhibited ulcerative colitis (UC) flare-up and enterocolitis during treatment with nivolumab for renal cell carcinoma [not all outcomes and durations of treatments to reaction onsets stated]. The man had a history of mild ulcerative colitis (proctitis form), partial nephrectomy, right renal cell carcinoma, total right nephrectomy, lung metastasis, depression, bone metastasis and gastric metastasis. He had received mesalazine [5-aminosalicylic acid], interferon-α and radiotherapy in the past. At the age of 76 years and 3 months, he started receiving oral axitinib 10 mg/day for renal cell carcinoma as the second-line therapy. Subsequently, lung and metastatic bone foci shrank, but he developed diarrhoea, severe general malaise and loss of appetite. Hence, the man discontinued axitinib. At the age of 76 years and 6 months, his general health recovered and he started receiving nivolumab 3 mg/kg every 2 weeks as third-line therapy [route not stated]. Three months after administering nivolumab, he developed a diarrhoea six times a day. Total colonoscopy revealed a flare-up of UC with a Mayo endoscopic subscore (MES) of 2, extending from the rectum to the ascending colon. He temporarily stopped receiving nivolumab and these symptoms diminished. On the subsequent month, nivolumab was restarted. After 3 months of restarting nivolumab, the man developed diarrhoea eight times a day along with bloody stools. This UC was given a Mayo score of 9. According to the CTCAE, diarrhoea was judged to be grade 3 and he was hospitalised. CT scan showed inflammation throughout the colon. After hospitalisation endoscopy showed a more severe exacerbation than before with an MES of 3. Histological analysis showed chronic inflammatory cell infiltrate in the stroma, crypt abscesses, erosion, reduced goblet cells, irregular duct layout and cryptitis. Based on these findings UC flare-up was concluded. Meanwhile, after recognising increasing apoptosis, a possibility of PD-1 inhibitor [nivolumab]-induced enterocolitis was considered. Subsequently, nivolumab was discontinued. Mesalazine dose was increased. A rapid improvement in symptoms were noted. On day 15 of hospitalisation, he was discharged. After discharge, he continued taking mesalazine without a decrease in his renal function and maintained a Mayo score of 0. After 2 months, a total colonoscopy showed continued remission with an MES of 0. But, the lung metastasis enlarged and new liver metastasis was noted. He was then started on oral low-dose axitinib 5 mg/day because he showed a reduction in tumour size before on axitinib. Although he again developed diarrhoea three times a day. As he showed remission, axitinib therapy was continued. Iwamoto M, et al. Remission of ulcerative colitis flare-up induced by nivolumab. International Journal of Colorectal Disease 35: 1791-1795, No. 9, 26 May 2020. Available 803504538 from: URL: h