Small bowel hemorrhage from check point inhibitor enteritis: a case report
Kellie Young1, Emery Lin2,3, Emerson Chen4
1Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR, USA. kellie.sy.young@gmail.com.
BMC Gastroenterology
|September 8, 2021
Summary
Immune checkpoint inhibitor (ICI) enteritis causing severe small bowel bleeding is rare. This case highlights the need for close monitoring and considering infliximab for steroid-refractory disease.
Area of Science:
- Oncology
- Gastroenterology
- Immunotherapy
Background:
- Immune checkpoint inhibitors (ICIs) are increasingly used for metastatic cancers.
- Gastrointestinal side effects are common, but isolated ICI-induced enteritis with small bowel hemorrhage is rare.
Observation:
- A patient on atezolizumab developed severe duodenal and jejunal ulcers with hemorrhage.
- Initial treatment with steroids was ineffective, leading to hemorrhagic shock.
Findings:
- Endoscopic and angiographic findings revealed active bleeding from multiple small bowel ulcers.
- The patient required transfusions, small bowel resection, embolization, and ultimately infliximab therapy.
Implications:
- Severe ICI-enteritis can cause life-threatening gastrointestinal hemorrhage.
- Steroid-refractory cases warrant consideration of advanced therapies like infliximab.
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