A case of checkpoint inhibitor-induced celiac disease.

MedStar author(s):
Citation: Journal for Immunotherapy of Cancer. 7(1):203, 2019 08 05.PMID: 31383006Institution: MedStar Washington Hospital CenterDepartment: Medicine/Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Antineoplastic Agents, Immunological/ae [Adverse Effects] | *Celiac Disease/et [Etiology] | *Neoplasms/co [Complications] | Aged | Antineoplastic Agents, Immunological/tu [Therapeutic Use] | Biomarkers | Biopsy | Celiac Disease/di [Diagnosis] | Endoscopy, Gastrointestinal | Female | Humans | Immunohistochemistry | Intestinal Mucosa/me [Metabolism] | Intestinal Mucosa/pa [Pathology] | Molecular Targeted Therapy/ae [Adverse Effects] | Neoplasms/dt [Drug Therapy] | Nivolumab/ae [Adverse Effects] | Nivolumab/tu [Therapeutic Use] | Programmed Cell Death 1 Receptor/ai [Antagonists & Inhibitors]Year: 2019ISSN:
  • 2051-1426
Name of journal: Journal for immunotherapy of cancerAbstract: BACKGROUND: Immune checkpoint inhibitors (ICIs) have now become standard of care treatment for many malignancies. ICIs are associated with unique immune mediated adverse events (irAEs) due to dysregulation of immune activation. As treatment with ICIs is becoming more common, rare irAEs are also being recognized. Here we report a case of ICI-induced celiac disease.CASE: A 74-year-old Caucasian female with metastatic renal carcinoma received second line nivolumab (anti-PD1 antibody) after initial disease progression on sunitinib. Ipilimumab was added after she failed to respond to six cycles of nivolumab monotherapy. One week after her first cycle of combination treatment, she presented with nausea, vomiting, grade 1 diarrhea, and weight loss. She underwent endoscopy, which showed bile stasis in the stomach, normal appearing stomach mucosa, and nonbleeding erythematous mucosa in the duodenal bulb. Stomach biopsy showed moderate active chronic gastritis. Duodenal biopsy showed moderate chronic active duodenitis with focal neutrophilic cryptitis, mucosal erosions, villous atrophy, mildly increased intraepithelial lymphocytes, and moderate chronic inflammation in the lamina propria pathognomonic of celiac disease. Symptoms improved with gluten-free diet, twice-daily omeprazole and anti-emetics and she was able to continue on treatment.CONCLUSIONS: There has been only one published case reporting ICI-induced celiac disease. Our case report highlights a rare irAE (celiac disease) associated with ICI treatment. It is unclear whether the patient had previously undiagnosed celiac disease or whether ICIs triggered her enteritis. Our patient was able to continue treatment with ICIs with dietary modifications, suggesting correct diagnosis is critical for optimal patient outcome.All authors: Alsaadi D, Atkins MB, Charabaty A, Shah NJOriginally published: Journal for Immunotherapy of Cancer. 7(1):203, 2019 Aug 05.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-08-23
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Journal Article MedStar Authors Catalog Article 31383006 Available 31383006

BACKGROUND: Immune checkpoint inhibitors (ICIs) have now become standard of care treatment for many malignancies. ICIs are associated with unique immune mediated adverse events (irAEs) due to dysregulation of immune activation. As treatment with ICIs is becoming more common, rare irAEs are also being recognized. Here we report a case of ICI-induced celiac disease.

CASE: A 74-year-old Caucasian female with metastatic renal carcinoma received second line nivolumab (anti-PD1 antibody) after initial disease progression on sunitinib. Ipilimumab was added after she failed to respond to six cycles of nivolumab monotherapy. One week after her first cycle of combination treatment, she presented with nausea, vomiting, grade 1 diarrhea, and weight loss. She underwent endoscopy, which showed bile stasis in the stomach, normal appearing stomach mucosa, and nonbleeding erythematous mucosa in the duodenal bulb. Stomach biopsy showed moderate active chronic gastritis. Duodenal biopsy showed moderate chronic active duodenitis with focal neutrophilic cryptitis, mucosal erosions, villous atrophy, mildly increased intraepithelial lymphocytes, and moderate chronic inflammation in the lamina propria pathognomonic of celiac disease. Symptoms improved with gluten-free diet, twice-daily omeprazole and anti-emetics and she was able to continue on treatment.

CONCLUSIONS: There has been only one published case reporting ICI-induced celiac disease. Our case report highlights a rare irAE (celiac disease) associated with ICI treatment. It is unclear whether the patient had previously undiagnosed celiac disease or whether ICIs triggered her enteritis. Our patient was able to continue treatment with ICIs with dietary modifications, suggesting correct diagnosis is critical for optimal patient outcome.

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