Skip to main content

Advertisement

SpringerLink
Log in

Immune Checkpoint Inhibitor-Induced Colitis Successfully Followed up by Ultrasonography

  • Imaging
  • Published:
SN Comprehensive Clinical Medicine Aims and scope Submit manuscript

Abstract

Nivolumab is an immune checkpoint inhibitor (ICI), which is used for treatment of advanced malignancies. Diarrhea is a typical adverse effect of ICIs. Several endoscopic features of ICI-related colitis have been reported. Herein, we reported a case of ICI-related colitis, with successful follow-up using ultrasonography (US). A 54-year-old woman, diagnosed with renal cell carcinoma, underwent radical nephrectomy. Multiple liver and bone metastases appeared 6 months after surgery. She was prescribed sunitinib, which was discontinued, because of severe diarrhea. She was prescribed nivolumab after 1 week. However, she was hospitalized 9 days later, due to fever and diarrhea. US showed diffuse wall thickening from the cecum to the rectum. The wall layer structures were preserved, and thickening was observed mainly in the submucosa, but not in the mucosa, without a decrease in the echo level. Subsequently, sigmoidoscopy was performed. Severe edema was observed in the mucosa, without any erosion and granularity. She was clinically diagnosed with ICI-related colitis, and steroid therapy was administered. One week after steroid therapy, the diarrhea improved, and the earlier findings showed marked improvement on US. After another week of reduced steroid dose, US revealed further improvement, and she was discharged.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Geukes Foppen MH, Rozeman EA, van Wilpe S, et al. Immune checkpoint inhibition-related colitis: symptoms, endoscopic features, histology and response to management. ESMO Open. 2018;3:e000278.

    Article  Google Scholar 

  2. Verschuren EC, van den Eertwegh AJ, Wonders J, et al. Clinical, endoscopic, and histologic characteristics of Ipilimumab-associated colitis. Clin Gastroenterol Hepatol. 2016;14:836–42.

    Article  Google Scholar 

  3. Nishida M, Shigematsu A, Sato M, et al. Ultrasonographic evaluation of gastrointestinal graft-versus-host disease after hematopoietic stem cell transplantation. Clin Transplant. 2015;29:697–704.

    Article  Google Scholar 

  4. Kinoshita K, Katsurada T, Nishida M, et al. Usefulness of transabdominal ultrasonography for assessing ulcerative colitis: a prospective, multicenter study. J Gastroenterol. 2019; 54: 521-529.

    Article  Google Scholar 

  5. Institute NC(Common Terminology Criteria for Adverse Events (CTCAE) 5.0.

  6. Yamauchi R, Araki T, Mitsuyama K, et al. The characteristics of nivolumab-induced colitis: an evaluation of three cases and a literature review. BMC Gastroenterol 2018 18:135.

    Article  Google Scholar 

  7. Dranoff G Immunotherapy at large: Balancing tumor immunity and inflammatory pathology. Nat Med 2013 19:1100-1101.

    Article  CAS  Google Scholar 

  8. Wang DY, Ye F, Zhao S, et al. Incidence of immune checkpoint inhibitor-related colitis in solid tumor patients: A systematic review and meta-analysis. Oncoimmunology 2017 6:e1344805.

    Article  Google Scholar 

  9. Celli R, Kluger HM and Zhang X Anti-PD-1 Therapy-Associated Perforating Colitis. Case Rep Gastrointest Med 2018:3406437.

  10. Brahmer JR, Lacchetti C, Schneider BJ, et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2018 36:1714-1768.

  11. Haanen J, Carbonnel F, Robert C, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017 28:iv119-iv142.

    Article  CAS  Google Scholar 

  12. Mouri A, Kaira K, Yamaguchi O, et al. Clinical difference between discontinuation and retreatment with nivolumab after immune-related adverse events in patients with lung cancer. Cancer Chemother Pharmacol 2019 84:873-880.

    Article  CAS  Google Scholar 

  13. Santini FC, Rizvi H, Plodkowski AJ, et al. Safety and Efficacy of Re-treating with Immunotherapy after Immune-Related Adverse Events in Patients with NSCLC. Cancer Immunol Res 2018 6:1093-1099.

    Article  CAS  Google Scholar 

  14. Kim KW, Ramaiya NH, Krajewski KM, et al. Ipilimumab-associated colitis: CT findings. AJR Am J Roentgenol 2013 200:W468-474.

    Article  Google Scholar 

  15. Peloquin JM, Pardi DS, Sandborn WJ, et al. Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol 2008 103:2015-2022.

  16. Jaffe TA, Gaca AM, Delaney S, et al. Radiation doses from small-bowel follow-through and abdominopelvic MDCT in Crohn's disease. AJR Am J Roentgenol 2007 189:1015-1022.

    Article  Google Scholar 

  17. Parente F, Greco S, Molteni M, et al. Imaging inflammatory bowel disease using bowel ultrasound. Eur J Gastroenterol Hepatol 2005 17:283-291.

    Article  Google Scholar 

  18. Parente F, Molteni M, Marino B, et al. Bowel ultrasound and mucosal healing in ulcerative colitis. Dig Dis 2009 27:285-290.

    Article  CAS  Google Scholar 

  19. Allocca M, Fiorino G, Bonovas S, et al. Accuracy of Humanitas Ultrasound Criteria in Assessing Disease Activity and Severity in Ulcerative Colitis: A Prospective Study. J Crohns Colitis 2018 12:1385-1391.

    Article  Google Scholar 

  20. Omotehara S, Nishida M, Kinoshita K, et al. Validation of US evaluation of ulcerative colitis activity. Ultrasound Med Biol 2019 45:1537-1544.

    Article  Google Scholar 

  21. Kubo K, Kato M and Mabe K Nivolumab-Associated Colitis Mimicking Ulcerative Colitis. Clin Gastroenterol Hepatol 2017 15:A35-A36.

    Article  Google Scholar 

  22. Yanai S, Nakamura S and Matsumoto T Nivolumab-Induced Colitis Treated by Infliximab. Clin Gastroenterol Hepatol 2017 15:e80-e81.

    Article  Google Scholar 

  23. Gonzalez RS, Salaria SN, Bohannon CD, et al. PD-1 inhibitor gastroenterocolitis: case series and appraisal of 'immunomodulatory gastroenterocolitis'. Histopathology 2017 70:558-567.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, Japan

    Satomi Omotehara, Mutsumi Nishida, Junichi Sugita & Takanori Teshima

  2. Diagnostic Center for Sonography, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, Japan

    Satomi Omotehara, Mutsumi Nishida & Hitoshi Shibuya

  3. Department of Gastroenterology and Hepatology, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, Japan

    Kazunori Nagashima

  4. Division of Endoscopy, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, Japan

    Takehiko Katsurada

  5. Department of Cancer Center, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, Japan

    Tetsuhito Muranaka & Yoshito Komatsu

  6. Department of Surgical Pathology, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, Japan

    Tomoko Mitsuhashi

  7. Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, N14 W5, Kita-ku, Sapporo, Japan

    Takashige Abe, Ryuji Matsumoto & Nobuo Shinohara

  8. Department of Hematology, Graduate School of Medicine, Hokkaido University, N14 W5, Kita-ku, Sapporo, Japan

    Junichi Sugita & Takanori Teshima

Authors
  1. Satomi Omotehara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mutsumi Nishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kazunori Nagashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takehiko Katsurada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tetsuhito Muranaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshito Komatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tomoko Mitsuhashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hitoshi Shibuya
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Takashige Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ryuji Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Nobuo Shinohara
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Junichi Sugita
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Takanori Teshima
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mutsumi Nishida.

Ethics declarations

Conflict of Interest

Yoshito Komatsu received lecture fees from Eli Lilly Japan K.K., ONO PHARMACEUTICAL CO., Ltd., TAIHO Phamaceutical CO., Ltd., Chugai Phamaceutical CO., Ltd., Takeda Pharmaceutical CO., Ltd., Bayer Yakuhin, Ltd., Bristol-Myers Squibb Co., Sanofi-aventis S.A., Merck Biopharma Co., Ltd., Yakult Honsha Ltd., Pfizer Japan Inc. and received a research grant from Mediscience Planning Inc.

Nobuo Shinohara received lecture fees from Pfizer Japan Inc., ONO PHARMACEUTICAL CO., Ltd., Novartis Pharma K.K., Bayer Yakuhin, Ltd., Astellas Pharma Inc., Takeda Pharmaceutical CO., Ltd., GSK, AstraZeneca, Janssen Pharmaceutical K.K., and MSD and received a research grant from ONO Phamaceutical CO., Ltd. and Astellas Pharma Inc.

Takanori Teshima received personal fees from Merck Sharp & Dohme Corp, grants and personal fees from Kyowa Hakko Kirin Co., Ltd., personal fees from Takeda Pharmaceutical CO., Ltd., grants, personal fees and non-financial support from Novartis Pharma K.K., personal fees from Pfizer Japan Inc., personal fees from Bristol-Myers Squibb, grants from Chugai Pharmaceutical Co., Ltd., grants from Sanofi K K, grants from Astellas Pharma Inc., grants from TEIJIN PHARMA LIMITED., grants from Fuji Pharma Co., Ltd., grants from NIPPON SHINYAKU CO., Ltd., non-financial support from Janssen Pharmaceutical K.K.

Satomi Omotehara, Mutsumi Nishida, Kazunori Nagashima, Takehiko Katsurada, Tetsuhito Muranaka, Tomoko Mitsuhashi, Hitoshi Shibuya, Takashige Abe, Ryuji Matsumoto and Junichi Sugita declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

The patient provided informed consent for the publication of this report.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Imaging

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Omotehara, S., Nishida, M., Nagashima, K. et al. Immune Checkpoint Inhibitor-Induced Colitis Successfully Followed up by Ultrasonography. SN Compr. Clin. Med. 2, 215–221 (2020). https://doi.org/10.1007/s42399-019-00211-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s42399-019-00211-0

Keywords

Search

Navigation