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Inflammatory Bowel Disease I: Ulcerative Colitis01:27

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Acute diarrhea, a common gastrointestinal disturbance, is characterized by the rapid evacuation of fluid stools, leading to an excessive weight in fluid. This condition typically arises from disorders affecting intestinal water and electrolyte transport. It can be triggered by an increased osmotic load within the intestine, excessive secretion of electrolytes and water, mucosal exudation of protein and fluid, or altered intestinal motility. The primary risks of acute diarrhea are dehydration...
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Laxatives are primarily used to alleviate constipation, a common gastrointestinal disorder characterized by infrequent bowel movements and difficulty passing stools. They work by various mechanisms to increase the volume or frequency of bowel movements. The primary modes of action of laxatives include increasing stool bulk, softening the stool, stimulating intestinal motility, and osmotically drawing water into the intestines.
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The gut microbiome is formed by a vast and diverse community of bacteria that colonizes our large intestine. These bacteria start residing in the gut from birth and continue diversifying throughout life, influenced by factors such as diet, lifestyle, and stress. The gut bacterial community also includes bacteria from food and those that enter the colon through the anus.
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Pseudomembranous Colitis: Unveiling an Infrequent Culprit Beyond Clostridium difficile-A Case Report.

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  • 1Department of Internal Medicine, The Brooklyn Hospital Centre, NY, USA.

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Summary

Immunotherapy can cause pseudomembranous colitis (PMC), a rare condition. This case highlights diagnostic challenges and successful steroid treatment for this adverse effect in a patient with advanced gastric cancer.

Keywords:
colitisimmune checkpoint inhibitorsimmunotherapynivolumabpseudomembranous colitis

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Area of Science:

  • Gastroenterology
  • Oncology
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) are increasingly used for advanced malignancies.
  • Immunotherapy-induced pseudomembranous colitis (PMC) is an uncommon but recognized adverse effect of ICIs.
  • PMC diagnosis can be challenging due to overlapping features with other colitis types.

Purpose of the Study:

  • To present a case of immunotherapy-induced PMC in a patient with gastric adenocarcinoma.
  • To highlight the diagnostic difficulties associated with atypical, diffuse colonic involvement in immunotherapy-related colitis.
  • To emphasize the need for increased clinical awareness and further research into immunotherapy-induced colitis (IMC).

Main Methods:

  • Case report of a 68-year-old male with gastric adenocarcinoma receiving immunotherapy and chemotherapy.
  • Exclusion of common etiologies, including Clostridium difficile infection (CDI).
  • Diagnostic colonoscopy with biopsy, revealing findings consistent with PMC.
  • Treatment with steroid therapy.

Main Results:

  • The patient presented with symptoms consistent with PMC, and common causes were ruled out.
  • Colonoscopy showed severe mucosal congestion and exudates, indicative of PMC.
  • The patient responded well to steroid therapy, with gradual improvement.
  • This case illustrates the diagnostic challenges of immunotherapy-induced PMC, especially with diffuse colonic involvement.

Conclusions:

  • Immunotherapy-induced PMC requires heightened clinical suspicion, particularly in patients with advanced cancer receiving ICIs.
  • The overlapping clinical, endoscopic, and histopathological findings with other colitis forms complicate timely diagnosis.
  • Further research is essential to refine diagnostic criteria and management strategies for immunotherapy-induced colitis.