Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2024; 16(7): 2329-2336
Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.2329
Multidisciplinary management of ulcerative colitis complicated by immune checkpoint inhibitor-associated colitis with life-threatening gastrointestinal hemorrhage: A case report
Na Hong, Bo Wang, Hang-Cheng Zhou, Zheng-Xiang Wu, Hua-Ying Fang, Geng-Qing Song, Yue Yu
Na Hong, Bo Wang, Zheng-Xiang Wu, Hua-Ying Fang, Yue Yu, Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Hang-Cheng Zhou, Department of Pathology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230036, Anhui Province, China
Hang-Cheng Zhou, Intelligent Pathology Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230036, Anhui Province, China
Geng-Qing Song, Department of Gastroenterology and Hepatology, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH 44109, United States
Co-first authors: Na Hong and Bo Wang.
Co-corresponding authors: Geng-Qing Song and Yue Yu.
Author contributions: Hong N conceived the study, analyzed and interpreted the data, drafted the article, and revised it critically for important intellectual content; Wang B and Zhou HC helped acquire the data and drafted the article; Wu ZX and Fang HY helped collect and analyze the data; Both Song GQ and Yu Y have played important and indispensable roles in the study design, data interpretation and manuscript preparation as the co-corresponding authors. Song GQ was responsible for data re-analysis and re-interpretation, literature search, the early revised version of the manuscript. Yu Y searched comprehensive literature and revised it critically for important intellectual content, approved the version to be submitted. This collaboration between Song GQ and Yu Y is crucial for the publication of this manuscript and other manuscripts still in preparation. All the authors have read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 31870993.
Informed consent statement: The patient and his wife for their consent to publish their case.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yue Yu, MD, PhD, Chief Doctor, Chief Physician, Professor, Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei 230001, Anhui Province, China. yuyuemd@163.com
Received: February 24, 2024
Revised: May 26, 2024
Accepted: June 18, 2024
Published online: July 27, 2024
Processing time: 148 Days and 21.5 Hours
Abstract
BACKGROUND

Programmed cell death 1 (PD-1) inhibitors are immune checkpoint inhibitors (ICI) that have demonstrated significant efficacy in treating various advanced malignant tumors. While most patients tolerate treatment well, several adverse drug reactions, such as fatigue, myelosuppression, and ICI-associated colitis, have been reported.

CASE SUMMARY

This case involved a 57-year-old male patient with ulcerative colitis complicated by hepatocarcinoma who underwent treatment with tirelizumab (a PD-1 inhibitor) for six months. The treatment led to repeated life-threatening lower gastrointestinal hemorrhage. The patient received infliximab, vedolizumab, and other salvage procedures but ultimately required subtotal colectomy due to uncontrollable massive lower gastrointestinal bleeding. Currently, postoperative gastrointestinal bleeding has stopped, the patient’s stool has turned yellow, and his full blood cell count has returned to normal.

CONCLUSION

This case highlights the necessity of early identification, timely and adequate treatment of ICI-related colitis, and rapid escalation to achieve the goal of improving prognosis.

Keywords: Ulcerative colitis; Hepatocarcinoma; Immune checkpoint inhibitor-associated colitis; Colectomy; Case report

Core Tip: Immune checkpoint inhibitors (ICIs), such as ICI-associated colitis, have demonstrated significant efficacy in treating various advanced malignant tumors, but several immune-related adverse drug reactions, such as ICI-associated colitis, have attracted increasing attention. In this article, we present a case of a patient with hepatocarcinoma and ulcerative colitis with ICI-related colitis in which repeated life-threatening lower gastrointestinal hemorrhage occurred during the disease course. Despite comprehensive salvage treatments through multidisciplinary management, the patient eventually required surgical intervention due to persistent gastrointestinal bleeding. This case highlights the necessity of early identification, timely and adequate treatment of ICI-related colitis and rapid escalation to improve patient prognosis.