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Celiac-like enteropathy and asthenia: case report A 58-year-old man developed celiac-like enteropathy during treatment with nivolumab. Additionally, he developed asthenia during treatment with cabozantinib for metastatic renal cell carcinoma (RCC) [not all routes, dosages and outcomes stated; time to reactions onset not stated]. The man had a medical history of insulin‐requiring diabetes and hypercholesterolaemia. Subsequently, he was diagnosed with RCC. Recurrence of the RCC was diagnosed at several locations such as right kidney, adrenal glands, lungs and lumbar‐aortic lymph nodes in 2014 for which he received therapy with sunitinib [Sutent]. He was noted to have a right testicular metastasis and underwent orchiectomy in 2017. In January 2018, a progression of target lesions was noted. He received first IV injection of nivolumab at a dose of 3 mg/kg (240mg) on 9 February 2018. The treatment was scheduled for one IV infusion every 2 weeks. After two injections of nivolumab (March 2018), he exhibited biological signs of diabetic decompensation and hyperthyroidism. Thus, man’s treatment with nivolumab was stopped. His TSH level was decreased. Anti-thyroperoxidase and antithyroglobulin antibodies were positive. One month after the last injection of nivolumab (April 2018), he was admitted again due to vomiting, weight loss and diarrhoea. Subsequently, he was noted to have mesenteric lymph with moderate overall distension of the small bowel loops. Stool culture was positive for Arcobacter butzleri. Therefore, he was treated with azithromycin and fluoroquinolones. Eventually, his condition deteriorated with signs of septic shock and Citrobacter freundii infection. Then, he was transferred to the ICU and stayed there from the 9–14 May 2018. He received treatment with ceftriaxone, ornidazole and norepinephrine. However, his condition deteriorated, and he developed severe anorexia, vomiting, and profuse, especially nocturnal diarrhoea, complicated by malnutrition. Thus, he received parenteral nutrition. The blood tests revealed the biological signs of malabsorption with profound hypoalbuminaemia, decreased serum level of iron and folic acid, hypomagnesaemia and hypocalcaemia. He was noted to have the same aspect of the overall distension of the small bowel loops. Duodenal biopsies revealed subtotal villous atrophy with chronic duodenitis, with an abundant lymphocyte CD3+, CD4+, CD8+ infiltration and intraepithelial lymphocytosis. The parenteral nutrition was continued due to oral alimentation intolerance. Enteral immune toxicity was suspected, and he started receiving treatment with methylprednisolone. He was considered to have developed celiac-like enteropathy secondary to nivolumab. After only 2 days, the symptoms improved with a spectacular decrease in stool frequency. He continued the treatment with methylprednisolone. Eventually, he was discharged and started receiving hydrocortisone due to his history of adrenalectomy. Four months after the discharge (10 October 2018), he was in a good general statu