Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
Division of Diagnostic Pathology/Surgical Pathology, University of Fukui Hospital, Fukui, Japan.
Clin J Gastroenterol. 2021 Dec;14(6):1692-1699. doi: 10.1007/s12328-021-01499-z. Epub 2021 Aug 20.
Immune checkpoint inhibitors have been shown to be effective for treating many carcinomas. However, the activated immune response may lead to the development of multiple immune-related adverse events, including rare immune-mediated inflammation due to autoimmune mechanisms. An 82-year-old man was diagnosed with large cell lung cancer (T1aN3M1 stage IVB) and was treated with inhibitors of the programmed cell death receptor-1, pembrolizumab. Diarrhea and melena occurred after six doses of pembrolizumab, and colonoscopy revealed mucosal inflammation of the rectum and sigmoid colon in a continuous manner, resembling the typical endoscopic findings of ulcerative colitis. Subsequently, fever and hyperamylasemia appeared, and the patient was diagnosed with pancreatitis resembling type 2 autoimmune pancreatitis on imaging tests and cytological examination, which showed infiltration of inflammatory cells, mainly neutrophils. Steroid therapy was administered and both, colitis and pancreatitis markedly improved. Here, we present a patient who developed colitis and pancreatitis after ICI treatment for advanced lung cancer. Both are thought to be due to autoimmune side effects of pembrolizumab. Although pancreatitis is a rare irAE, clinicians should be aware of the development of pancreatitis, especially in the case of irAE colitis resembling ulcerative colitis.
免疫检查点抑制剂已被证明可有效治疗多种癌。然而，激活的免疫反应可能导致多种免疫相关不良事件的发生，包括罕见的免疫介导的炎症，其由自身免疫机制引起。一名 82 岁男性被诊断为大细胞肺癌（T1aN3M1 期 IVB 期），并接受了程序性细胞死亡受体-1 抑制剂 pembrolizumab 的治疗。在接受了六剂 pembrolizumab 后，患者出现腹泻和黑便，结肠镜检查显示直肠和乙状结肠的黏膜炎症呈连续状，类似于溃疡性结肠炎的典型内镜表现。随后，患者出现发热和高淀粉酶血症，影像学检查和细胞学检查提示为类似于 2 型自身免疫性胰腺炎的胰腺炎，检查结果显示炎症细胞浸润，主要为中性粒细胞。给予皮质类固醇治疗后，结肠炎和胰腺炎均明显改善。在此，我们报告了一例接受晚期肺癌 ICI 治疗后发生结肠炎和胰腺炎的患者。这两种疾病均被认为是 pembrolizumab 的自身免疫副作用所致。尽管胰腺炎是一种罕见的免疫相关不良反应，但临床医生应注意胰腺炎的发生，尤其是类似于溃疡性结肠炎的免疫相关结肠炎的情况下。
