Ulcerative colitis exacerbation after the onset of immune checkpoint inhibitor related colitis
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CASE REPORT
Ulcerative colitis exacerbation after the onset of immune checkpoint inhibitor related colitis Atsuto Kayashima1 · Keitaro Shimozaki1 · Kenro Hirata1 · Makoto Mutaguchi2 · Kaoru Takabayashi2 · Yuichiro Hayashi3 · Naoki Hosoe2 · Haruhiko Ogata2 · Tomohisa Sujino1 · Takanori Kanai1 Received: 16 July 2020 / Accepted: 1 October 2020 © Japanese Society of Gastroenterology 2020
Abstract Immune checkpoint inhibitors (ICPI) have been reported to be effective in various carcinomas. They excessively activate the immune system, resulting in frequent immune-related adverse events (irAEs). Colitis induced by ICPI is one of the most common and is known as immune-mediated colitis (IMC). Although IMC and inflammatory bowel disease (IBD) are similar in many respects, there are very few reports of IMC in patients with preexisting IBD such as ulcerative colitis (UC) and Crohn’s disease (CD). Whether preexisting IBD is concerned with the development of the colitis is not well known. Here, we reported the case who developed severe ulcerative colitis which started from IMC. It is an important case to follow the time course of the colitis developed. Our conclusion indicated that frequent colonoscopy was important for the management of IMC in a patient who has suffered chronic inflammatory disease, such as UC. Keywords Ulcerative colitis · Immune checkpoint inhibitor · irAE · Immune-mediated colitis · PD-1
Introduction Immune checkpoint inhibitors (ICPI) targeting anticytotoxic T-lymphocyte-associated protein 4 (CTLA-4), anti-programmed cell death protein-1 (PD-1) and antiprogrammed death ligand-1 (PD-L1), have been reported to be effective in various carcinomas. The number of ICPI treatments is increasing, and it is expected to increase in the future. However, they excessively activate the immune system, resulting in frequent immune-related adverse events (irAEs). These irAEs are caused in all various organs, such as colitis, interstitial pneumonia, endocrine dysfunction, skin disorders, renal disorders, liver disorders, neuropathy, etc. and are very different from the adverse events associated with conventional chemotherapy as represented by nausea, * Tomohisa Sujino [email protected] 1
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35, Shinanomachi, Shinjuku‑ku, Tokyo 160‑8582, Japan
2
Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
3
Department of Pathology, School of Medicine, Keio University, Tokyo, Japan
loss of appetite, myelosuppression. There are various reports on the appearance time of irAEs, but it is difficult to predict. And the irAEs diagnosis and treatment are often difficult, and the ICPI administration that had been effective may be interrupted or stopped. Therefore, appropriate correspondence for irAEs is very important for ICPI treatment. Among them, colitis induced by ICPI is one of the most common and the main symptoms are diarrhea, bloody stools, and abdominal pai
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