A Celiac Disease Phenotype After Checkpoint Inhibitor Exposure: An Example of Immune Dysregulation After...

Area of Science:

• Gastroenterology
• Immunology
• Oncology

Background:

• Celiac disease involves duodenal inflammation triggered by gluten.
• Checkpoint inhibitors, like pembrolizumab, enhance anti-tumor responses by modulating cytotoxic T lymphocytes.
• The potential for immunotherapy to induce or unmask autoimmune conditions is an emerging area of research.

Observation:

• A 79-year-old man with undiagnosed celiac disease received pembrolizumab.
• He later experienced diarrhea and weight loss.
• Diagnostic tests confirmed celiac disease.

Findings:

• Pembrolizumab treatment preceded the onset of celiac disease symptoms.
• Withdrawal of pembrolizumab and steroid administration led to symptom resolution.
• A gluten-free diet was ineffective.

Implications:

• This case suggests a potential association between pembrolizumab and the development or exacerbation of celiac disease.
• Further research is needed to understand the mechanisms linking checkpoint inhibitors and celiac disease.
• Clinicians should consider celiac disease in patients on immunotherapy presenting with gastrointestinal symptoms.