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Enhancer of Zeste Homolog 1 and 2 Inhibitor-Induced Colitis Mimicking Immune Checkpoint Inhibitor-Induced Colitis
Keisuke Iwata1, Kenji Yamazaki1, Ryoji Kushima2
1Department of Gastroenterology, Gifu Prefectural General Medical Center, Japan.
Abstract:
An 80-year-old woman with relapsed nodal T-follicular helper cell lymphoma, not otherwise specified, developed severe watery diarrhea during valemetostat therapy. Colonoscopy revealed diffuse mucosal erythema and edema, and a biopsy showed lymphoplasmacytic infiltration, crypt abscesses, and apoptotic bodies, consistent with immune checkpoint inhibitor-induced colitis. Immunohistochemistry revealed CD3-positive T cell predominance with abundant CD8-positive cells. Diarrhea improved after discontinuation of the drug without additional therapy. To the best of our knowledge, this is the first reported case of enhancer of zeste homolog 1 and 2 (EZH1/2) inhibitor-induced colitis. EZH1/2 inhibition may lead to T cell-mediated intestinal injury through epigenetic dysregulation; therefore, patients receiving EZH1/2 inhibitors who develop persistent diarrhea should undergo early endoscopic and histological evaluations.
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