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Ipilimumab-Induced Enteritis without Colitis: A New Challenge.
Marcus Messmer1, Sunita Upreti2, Yaman Tarabishy3
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ipilimumab can cause severe diarrhea due to enteritis, a condition distinct from enterocolitis. Prompt steroid treatment is effective for this immune-related adverse event in melanoma patients.
Area of Science:
- Oncology
- Immunology
- Gastroenterology
Background:
- Ipilimumab, a CTLA-4 inhibitor, treats metastatic melanoma and prolongs survival.
- Immune-related adverse events are common with ipilimumab, including enterocolitis.
- Enteritis without colitis induced by ipilimumab has not been previously described.
Observation:
- An 83-year-old male presented with grade 3 diarrhea and electrolyte disturbances after starting ipilimumab.
- Infectious causes were excluded, and initial treatment for enterocolitis with corticosteroids was ineffective.
- Colonoscopy revealed normal mucosa, prompting further investigation.
Findings:
- Upper endoscopy with enteroscopy showed duodenal inflammation and villous blunting consistent with ipilimumab-induced injury.
- Recurrence of symptoms upon steroid weaning confirmed the link to ipilimumab.
- High-dose steroids led to symptom resolution.
Implications:
- Ipilimumab-induced enteritis is a serious immune-related adverse event requiring prompt recognition and management.
- Steroids are an effective treatment for ipilimumab-induced enteritis, similar to enterocolitis.
- Clinicians should suspect enteritis without colitis in ipilimumab-treated patients with severe diarrhea and normal colonoscopy findings.
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