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A case of immune checkpoint inhibitor-related colitis with a distinctive endoscopic finding of colonic pseudolipomatosis

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Abstract

A man in his 70s received anticancer chemotherapy with the anti-programmed cell death protein–ligand 1 antibody atezolizumab for non-small cell lung cancer. Ten days later, he developed diarrhea and skin rash, which were suspected to be due to immune-related adverse events, and was treated with prednisolone for 2 weeks. Five weeks after atezolizumab administration, he was admitted to our hospital for Common Terminology Criteria for Adverse Events Grade 3 diarrhea and hematochezia. Sigmoidoscopy revealed a dark red color in the mucosa of the transverse colon and multiple whitish mucosal plaques extending from the transverse colon to the rectum. Biopsy specimens revealed empty vacuoles in the lamina propria with infiltration of numerous inflammatory cells, including CD8+ T cells. Based on the findings of sigmoidoscopy and histology, the diagnosis was immune checkpoint inhibitor-related colitis with colonic pseudolipomatosis. The endoscopic findings and symptoms were markedly improved by prednisolone administration. We herein report the first case of immune checkpoint inhibitor-related colitis with characteristic endoscopic findings of colonic pseudolipomatosis. It is important to perform endoscopy and histological evaluation to determine the differential diagnosis and treatment strategy for patients treated with immune checkpoint inhibitors.

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Acknowledgements

This research was partially supported by AMED under Grant Number JP21fk0210077, JP21fk0210047, and JP21fk0210058 and JSPS KAKENHI Grant-in-Aid for Scientific Research Numbers 20K17018.

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Authors and Affiliations

  1. Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Tatsushi Naito, Takuto Nosaka, Kazuto Takahashi, Kazuya Ofuji, Hidetaka Matsuda, Masahiro Ohtani, Katsushi Hiramatsu & Yasunari Nakamoto

  2. Division of Diagnostic Pathology/Surgical Pathology, University of Fukui Hospital, Fukui, Japan

    Yoshiaki Imamura

  3. Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan

    Tamotsu Ishizuka

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  1. Tatsushi Naito
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  2. Takuto Nosaka
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  3. Kazuto Takahashi
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  4. Kazuya Ofuji
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  5. Hidetaka Matsuda
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  6. Masahiro Ohtani
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  7. Katsushi Hiramatsu
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  8. Yoshiaki Imamura
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  9. Tamotsu Ishizuka
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  10. Yasunari Nakamoto
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Correspondence to Yasunari Nakamoto.

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All procedures followed were in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Naito, T., Nosaka, T., Takahashi, K. et al. A case of immune checkpoint inhibitor-related colitis with a distinctive endoscopic finding of colonic pseudolipomatosis. Clin J Gastroenterol 14, 1431–1436 (2021). https://doi.org/10.1007/s12328-021-01459-7

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  • DOI: https://doi.org/10.1007/s12328-021-01459-7

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