Immune checkpoint inhibitor-induced colitis complicated with inflammatory intestinal obstruction: a case report and literature review.

Abstract

Background:

The combination therapy using anti-angiogenic drugs and immune checkpoint inhibitors (ICIs) has an excellent safety profile and manageable toxicity. However, ICI therapy may lead to a variety of autoimmune events, known as immune-related adverse events (irAEs), which some secondary complications may occur, such as immune-mediated colitis (IMC) and secondary inflammatory intestinal obstruction. It could impact clinical assessments and treatment decisions. Although there are few reports about secondary inflammatory intestinal obstruction related IMC.

Case Description:

We report an adult patient who suffered from primary liver cancer, who accepted ICIs (sintilimab) combined with vascular endothelial growth factor (VEGF) inhibitor (bevacizumab). He suffered worsening diarrhea about 5 days following immunotherapy. Computed tomography (CT) revealed the thickening intestinal wall of colon and rectum and massive cerebral gas in the proximal colon cavity. He was hospitalized with a diagnosis of IMC and inflammatory intestinal obstruction. Finally, he underwent the therapeutic option using combined glucocorticoid and somatostatin. His symptoms eased within 3 weeks and he was discharged from the hospital.

Conclusions:

IMC with diarrhea as the main manifestation requires early diagnosis and timely treatment. If the condition progresses, inflammatory intestinal obstruction may occur and this is a life-threatening situation. It is effective to accept early glucocorticoid and somatostatin while casual surgery may aggravate intestinal inflammation and injury, even death.

• Authors: Shunde Tan, Gang Zhu, Jun Fan, Jianfei Chen, Xinkai Li, Yisheng Peng, Song Su, Cheng Fang, Xiaoli Yang, Bo Li
• Journal: Translational cancer research (Transl Cancer Res) Vol. 11 Issue 7 Pg. 2443-2448 (Jul 2022) ISSN: 2219-6803 [Electronic] China
• PMID: 35966294 (Publication Type: Case Reports)
• Copyright: 2022 Translational Cancer Research. All rights reserved.