Wexham Park Hospital, Slough, UK
Royal Berkshire Hospital, Reading, UK.
BMJ Case Rep. 2024 May 8;17(5):e259057. doi: 10.1136/bcr-2023-259057.
A man in his 80s was undergoing immunotherapy with pembrolizumab, an anti-PD-1 monoclonal antibody, following his diagnosis of adenocarcinoma of primary lung origin. 24 weeks into treatment, the patient reported experiencing loose stools associated with malaise and poor appetite but no further symptoms. This progressed in frequency and a clinical diagnosis of grade 2 immune checkpoint inhibitor colitis was made. Management with oral prednisolone was commenced but symptoms persisted. Common enteric infections had been ruled out, as were coeliac disease and hyperthyroidism. Flexible sigmoidoscopy and colonoscopy results were not in keeping with colitis, having revealed normal looking mucosa. Following this, a faecal elastase level was found to be low. A diagnosis of pembrolizumab-induced pancreatic exocrine insufficiency was made, and stool frequency and consistency swiftly improved following the use of pancreatic enzyme replacement therapy.
一位 80 多岁的男性被诊断为原发性肺癌腺癌后，开始接受抗 PD-1 单克隆抗体 pembrolizumab 的免疫治疗。治疗 24 周后，患者报告出现稀便伴不适和食欲不振，但无其他症状。稀便的频率增加，临床诊断为 2 级免疫检查点抑制剂结肠炎。开始口服泼尼松龙治疗，但症状持续存在。已排除常见的肠道感染、乳糜泻和甲状腺功能亢进。软性乙状结肠镜和结肠镜检查结果与结肠炎不符，显示正常的黏膜。之后，粪便弹性蛋白酶水平较低。诊断为 pembrolizumab 诱导的胰腺外分泌功能不全，使用胰酶替代治疗后粪便频率和稠度迅速改善。
