Immune checkpoint inhibitor therapy associated enteritis mimicking celiac disease
Gastroenterology and Hepatology from Bed to Bench,
Vol. 16 No. 2 (2023),
21 April 2023
https://doi.org/10.22037/ghfbb.v16i2.2855
Abstract
A 68-year-old man with a previous history of lung cancer presented with deteriorating appetite and weight loss. Imaging revealed significant retroperitoneal lymphadenopathy, as well as liver and bone lesions consistent with widespread metastatic carcinoma. Biopsy results from the liver lesions confirmed the diagnosis of metastatic non-small cell lung carcinoma. A PDL-1 immunostain, performed on the initial lung resection specimen, showed a combined positive score (CPS) of 15 and pembrolizumab treatment was initiated. The patient presented with diarrhea three weeks after starting therapy and duodenal biopsies obtained at this time displayed intact villous architecture with an increase in intraepithelial lymphocytes (IELs). The colon biopsies exhibited lymphocytic colitis, characterized by significant thinning of the surface epithelium, a higher mixed inflammatory infiltrate within the lamina propria, and diffuse increase of IELs (greater than 30 per 100 epithelial cells). These findings collectively raised the differential diagnosis of celiac disease with lymphocytic colitis or immunotherapy-associated enterocolitis. Further serological testing for celiac disease, including anti-tissue transglutaminase antibodies, yielded negative results. Consequently, a final diagnosis of immune adverse event associated with immunotherapy was established. Cases reported in literature as celiac disease occurring soon after immunotherapy are likely misdiagnosed cases of immunotherapy enteritis.
- Non-small cell lung carcinoma, Celiac disease, Pembrolizumab, Duodenal biopsy.
How to Cite
References
Schadendorf D, Hodi FS, Robert C, Weber JS, Margolin K, Hamid O, et al. Pooled analysis of long-term survival data from Phase II and Phase III trials of ipilimumab in unresectable or metastatic melanoma. J Clin Oncol 2015;33:1889–1894.
Hodi FS, O'Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, et al. Improved Survival with Ipilimumab in Patients with Metastatic Melanoma. N Engl J Med 2010;363:711-723.
Basudan AM. The role of immune checkpoint inhibitors in cancer therapy. Clin Pract 2022;13:22-40.
Darnell EP, Mooradian MJ, Baruch EN, Yilmaz M, Reynolds KL. Immune-related adverse events (irAEs): diagnosis, management, and clinical pearls. Curr Oncol Rep 2020;22:39.
Johncilla M, Misdraji J, Pratt DS, Agoston AT, Lauwers GY, Srivastava A, et al. Ipilimumab-associated Hepatitis: Clinicopathologic Characterization in a Series of 11 Cases. Am J Surg Pathol 2015;39:1075-1084.
Brahmer JR, Abu-Sbeih H, Ascierto PA, Brufsky J, Cappelli LC, Cortazar FB, et al. Society for immunotherapy of cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer 2021;9:002435.
Chen FW, Liu A, Srivastava A, Buchbinder E, Grover S. Checkpoint inhibitor induced esophagitis with documented resolution on infliximab. Curr Probl Cancer Case Rep 2020;2:100029.
Acero Brand FZ, Suter N, Adam J-P, Faulques B, Maietta A, Soulières D, et al. Severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab. J Immunother Cancer 2018;6:22.
Johncilla M, Grover S, Zhang X, Jain D, Srivastava A. Morphological spectrum of immune check-point inhibitor therapy-associated gastritis. Histopathology 2020;76:531-539.
Cheung VTF, Brain O. Immunotherapy induced enterocolitis and gastritis - What to do and when? Best Pract Res Clin Gastroenterol 2020;48-49:101703.
Alruwaii ZI, Montgomery EA. Gastrointestinal and hepatobiliary immune-related adverse events: a histopathologic review. Adv Anat Pathol 2022;29:183-193.
Assarzadegan N, Montgomery E, Anders RA. Immune checkpoint inhibitor colitis: the flip side of the wonder drugs. Virchows Arch 2018;472:125-133.
Sethi A, Helfand A, Balikani L, Bunker M, Finley G. Association of celiac disease with pembrolizumab. Cureus 2021;13:15565.
Alsaadi D, Shah NJ, Charabaty A, Atkins MB. A case of checkpoint inhibitor-induced celiac disease. J Immunother Cancer 2019;7:203.
Hayashi Y, Hosoe N, Takabayashi K, Limpias Kamiya KJL, Tsugaru K, Shimozaki K, et al. Clinical, endoscopic, and pathological characteristics of immune checkpoint inhibitor-induced gastroenterocolitis. Dig Dis Sci 2021;66:2129-2134.
Isidro RA, Ruan AB, Gannarapu S, Raj D, Rahma O, Grover S, et al. Medication-specific variations in morphological patterns of injury in immune check-point inhibitor-associated colitis. Histopathology 2021;78:532-541.
Philip NA, Ahmed N, Pitchumoni CS. Spectrum of drug-induced chronic diarrhea. J Clin Gastroenterol 2017;51:111-117.
- Abstract Viewed: 393 times
- PDF Downloaded: 237 times