肠病原性大肠杆菌和细菌过度生长的联合感染加剧免疫检查点抑制剂诱导的大肠炎
Ermias A Kibru1, Abdul-Rahaman A Ottun1, John G Dusek2
1Internal Medicine, Piedmont Athens Regional Hospital, Athens, USA.
免疫检查点抑制剂诱导性结肠炎 (ICIC) 可能会因感染和细菌过度生长而恶化. 与炎症一起解决这些问题是患者康复和管理严重症状的关键.
科学领域:
- 胃肠病学 胃肠病学
- 免疫学 免疫学 免疫学
- 在瘤学瘤学.
背景情况:
- 免疫检查点抑制剂诱导性结肠炎 (ICIC) 是一种常见的胃肠道不良事件,特别是在联合伊皮利马布-尼沃马布治疗时.
- 严重的病例可能会出现显著的电解质干扰和长期疾病.
研究的目的:
- 报告严重的ICIC病例,并因同时感染和细菌过度生长而加剧.
- 突出综合诊断和多式疗法在管理复杂ICIC病例中的重要性.
主要方法:
- 一个患有转移性粘膜黑色素瘤的患者在组合免疫治疗中的病例介绍.
- 诊断评估包括多重便PCR,结肠镜与活检以及便研究.
- 治疗包括皮质类固醇,补充剂和小肠细菌过度生长 (SIBO) 的rifaximin.
主要成果:
- 患者出现严重的腹,低血糖,代谢性酸性疾病和QTc延长.
- 肠病原性大肠杆菌 (EPEC) 感染和SIBO被确定为导致因素.
- 通过解决炎症,感染和细菌过度生长的多式疗法实现了临床改善.
结论:
- 肠道病原体和细菌过度生长可以显著恶化ICIC,导致严重的电解质乱.
- 临床医生必须怀疑ICIC患者在不成比例的损失或对免疫抑制反应不良的情况下存在共感染.
- 综合评估和有针对性的多式疗法对于有效的ICIC管理至关重要,而不仅仅是皮质类固醇.
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