Pembrolizumab
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Colitis: case report A 66-year-old man developed colitis during treatment with pembrolizumab for lung cancer. The man, who had undergone previous surgery and chemotherapy for lung cancer, started receiving pembrolizumab [route and dosage not stated] following relapse of his condition. Three months later, he presented with diarrhoea, which started after his fifth dose of pembrolizumab. The man was initially treated with ciprofloxacin and metronidazole. Laboratory analyses at presentation revealed no leucocytes in stool microscopy, and no culture growth. Clostridium difficile toxins were found to be negative. He started receiving methylprednisolone; however, plentiful watery diarrhoea, 7–10 times a day, persisted. Stage III colitis was diagnosed. Pembrolizumab was discontinued. Ultrasound examination revealed thickness in the colonic wall. Colonoscopy performed 4 days post the last dose of pembrolizumab showed that the rectum was most severely effected, and the entire colon mucosa was inflamed. Oedematous and submucousal venous plexus disappeared. Severe active transmucosal colitis was observed during histopathological examination of colonic biopsies. Other findings included widespread patchy losses, crypt abscesses, significant mucin loss, epithelial flattening in crypts showing abscess formation, eosinophilic appearance with apoptosis and necrosis, cystic dilatation in some crypts and cell debris in lumens. His condition was attributed to immune-check point inhibitor therapy with pembrolizumab. Chest X-ray was performed, and he was treated with infliximab. Clinical response was achieved within 24 hours. His stools were initially watery and non-shaped, but became shaped in 2 weeks. He continued receiving methylprednisolone for a while; however, one month after treatment with infliximab, methylprednisolone was discontinued and the patient did not experience diarrhoea again. Pembrolizumab was not resumed. He later developed brain metastasis and died 5 months after initiation of infliximab. Author comment: "We would like to present colitis case immune related side effects due to pembrolizumab." Tiftikci A, et al. The use of infliximab in the treatment of immune related side effects: Case presentation. Turkish Journal of Gastroenterology 30 (Suppl. 3): S500 abstr. pp-459, 2019. Available from: URL: http://doi.org/10.5152/tjg.2019.050919 803436865 [abstract] - Turkey
0114-9954/19/1781-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 30 Nov 2019 No. 1781
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