Ai Qi, Chen Wen, Li Yonggui, Li Guoqing
The Second Affiliated Hospital, Department of Digestive Internal Medicine, Hengyang Medical School, University of South China, Hengyang, China.
Front Immunol. 2022 Jun 3;13:840916. doi: 10.3389/fimmu.2022.840916. eCollection 2022.
Immune checkpoint inhibitors (ICIs) have now become the standard therapy for malignancies like non-small cell lung cancer and classical Hodgkin's lymphoma. ICIs are associated with unique immune-related adverse events (irAEs) caused by dysregulated immune activation. Treatment of lower gastrointestinal (GI) tract irAEs, such as colitis, is more common. However, for upper gastrointestinal tract irAEs, there is a lack of consensus in terms of globally standardized disease classification and treatment guidelines. Here, we report a case of sintilimab-induced acute erosive hemorrhagic gastritis.
A 54-year-old man with metastatic NSCLC (PT2N2M1 stage IV) underwent treatment with eight courses of sintilimab + bevacizumab, followed by maintenance therapy with sintilimab alone. However, he presented with epigastric pain and melena at the end of the first sintilimab treatment, and the symptoms occurred repeatedly after regular treatment with acute erosive hemorrhagic gastritis. Repeat esophagogastroduodenoscopy (EGD) showed severe hemorrhagic gastritis; symptomatic relief and improvement in EGD images were noted for as long as he was being treated with steroids, methylprednisolone sodium.
As far as we are aware, we here describe the first case of sintilimab-associated acute erosive hemorrhagic gastritis, an upper gastrointestinal toxicity event. Throughout the treatment progression, differential diagnosis, multidisciplinary discussion, and the use of immunosuppressants were instrumental in clarifying the diagnosis and were crucial to the prognosis of the patient and continued treatment with ICIs.
免疫检查点抑制剂（ICIs）现已成为非小细胞肺癌和经典霍奇金淋巴瘤等恶性肿瘤的标准治疗方法。ICIs与免疫激活失调引起的独特免疫相关不良事件（irAEs）有关。下消化道（GI）道irAEs（如结肠炎）的治疗更为常见。然而，对于上消化道irAEs，在全球标准化疾病分类和治疗指南方面缺乏共识。在此，我们报告一例信迪利单抗诱导的急性糜烂性出血性胃炎病例。
一名54岁的转移性非小细胞肺癌（PT2N2M1 Ⅳ期）男性患者接受了8个疗程的信迪利单抗+贝伐单抗治疗，随后单独使用信迪利单抗进行维持治疗。然而，在首次使用信迪利单抗治疗结束时，他出现了上腹部疼痛和黑便，在接受急性糜烂性出血性胃炎的常规治疗后症状反复出现。重复食管胃十二指肠镜检查（EGD）显示严重出血性胃炎；只要他接受甲泼尼龙钠类固醇治疗，症状就会缓解，EGD图像也会改善。
据我们所知，我们在此描述了首例信迪利单抗相关的急性糜烂性出血性胃炎，这是一种上消化道毒性事件。在整个治疗过程中，鉴别诊断、多学科讨论和免疫抑制剂的使用有助于明确诊断，对患者的预后和继续使用ICIs治疗至关重要。
