Dilling Paweł, Walczak Jakub, Pikiel Paweł, Kruszewski Wiesław J
Pol Przegl Chir. 2014 Feb;86(2):94-6. doi: 10.2478/pjs-2014-0017.
Ipilimumab, an anticancer drug, is an anti-CTLA4 monoclonal antibody. It is used in treatment of disseminated melanoma. Therapy is associated with high risk of complications. One of the most serious, although one of the rarest is perforation of gastrointestinal tract. In this case report we describe a 52-year old male, with disseminated melanoma with unknown starting point, treated with anti- CTLA4 monoclonal antibody. After 3rd dose of drug administration, bloody diarrhea and acute abdominal pain occurred as a symptom of gastrointestinal perforation. A single perforation was sutured during laparotomy. Symptoms of acute abdomen returned after 10 days. Pus-faecalperitonitis, symptoms of necro-hemorrhagic colitis and multilocal perforation of the colon were found during relaparotomy. Pancolectomy with end ileostomy was performed. Few hours since relaparotomy pacient died due to multiple organ failure. The purpose of this case report is to draw attention to a risk of multilocal colon perforation in patient treated with ipilumumab.
伊匹单抗是一种抗癌药物，是一种抗细胞毒性T淋巴细胞相关抗原4（CTLA4）单克隆抗体。它用于治疗播散性黑色素瘤。该疗法伴有高并发症风险。其中最严重的一种，尽管也是最罕见的一种是胃肠道穿孔。在本病例报告中，我们描述了一名52岁男性，患有起始点不明的播散性黑色素瘤，接受了抗CTLA4单克隆抗体治疗。在第三次给药后，出现血性腹泻和急性腹痛，这是胃肠道穿孔的症状。剖腹手术期间缝合了单个穿孔。10天后急性腹痛症状复发。再次剖腹手术时发现了脓性粪性腹膜炎、坏死性出血性结肠炎症状和结肠多处穿孔。进行了全结肠切除术并做了末端回肠造口术。再次剖腹手术后数小时，患者因多器官衰竭死亡。本病例报告的目的是提醒人们注意接受伊匹单抗治疗的患者发生结肠多处穿孔的风险。
