Abu Khalaf S, Albarrak A, Yousef M, Tahan V. Immune checkpoint inhibitors induced colitis, stay vigilant: A case report. World J Gastrointest Oncol 2020; 12(6): 699-704 [PMID: 32699584 DOI: 10.4251/wjgo.v12.i6.699]
Corresponding Author of This Article
Suha Abu Khalaf, MD, Doctor, Resident Physician, Department of Internal Medicine, University of Missouri, 1 Hospital Dr, Columbia, MO 65212, United States. abukhalafs@health.missouri.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Jun 15, 2020; 12(6): 699-704 Published online Jun 15, 2020. doi: 10.4251/wjgo.v12.i6.699
Immune checkpoint inhibitors induced colitis, stay vigilant: A case report
Suha Abu Khalaf, Abdulmajeed Albarrak, Mohamad Yousef, Veysel Tahan
Suha Abu Khalaf, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
Abdulmajeed Albarrak, Department of Internal Medicine, College of Medicine, Qassim University, Buraydah 81999, Saudi Arabia
Abdulmajeed Albarrak, Mohamad Yousef, Veysel Tahan, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
Author contributions: Abu Khalaf S reviewed the literature, performed the data collection, reviewed the patient chart, and wrote the original manuscript; Albarrak A edited the manuscript and performed the colonoscopy, Yousef M edited the manuscript; Tahan V reviewed the manuscript, edited, supervised the first author, got the patient’s consent and performed the colonoscopy; all authors have read and agreed on the final version of the manuscript.
Informed consent statement: Informed written consent wasn’t obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Suha Abu Khalaf, MD, Doctor, Resident Physician, Department of Internal Medicine, University of Missouri, 1 Hospital Dr, Columbia, MO 65212, United States. abukhalafs@health.missouri.edu
Received: January 18, 2020 Peer-review started: January 18, 2020 First decision: April 16, 2020 Revised: May 7, 2020 Accepted: May 19, 2020 Article in press: May 19, 2020 Published online: June 15, 2020 Processing time: 149 Days and 4.6 Hours
Abstract
BACKGROUND
Colitis is one of the immune-related side effects of immunotherapy. Usually, such type of side effect was reported to develop within a few weeks of treatment initiation, our case started within a few days.
CASE SUMMARY
We present a case of a 37-year-old gentleman with bright red loose stools, abdominal pain, and tenesmus. A diagnosis of colitis was made based on endoscopic and histologic findings. Treatment was thereafter continued with oral steroids and discontinuation of the immunotherapy medications. Symptoms resolved after starting the treatment and the patient continued to be symptom-free on subsequent follow-up. The unique about this case report is that the patient developed bloody diarrhea within five days of the 1st immunotherapy cycle, and the patient was on combined ipilimumab and nivolumab.
CONCLUSION
Immunotherapy related complications might occur within days from being on immunotherapy; we need more research to open the way for future pathological and clinical research to further understand the pathophysiology behind it.
Core tip: Immunotherapy is one of the novel treatments of this century, though it can cause many predicted and unpredicted immune-related side effects. This is a rare case of immunotherapy induced colitis in an otherwise healthy male who was recently diagnosed with melanoma and was started on appropriate immunotherapy treatment. Clinicians should keep in mind the possible immune side effects of immune checkpoint inhibitors as they can develop at any stage, which will help physicians in stopping these medications earlier and avoiding further serious harm.
