Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea.
Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan 31151, Republic of Korea.
Medicina (Kaunas). 2024 Aug 30;60(9):1422. doi: 10.3390/medicina60091422.
Immune check inhibitor (ICI) colitis is one of most common and adverse side effects of ICI. However, there was no case report of ulcerative colitis (UC)-mimicking colitis after atezolizumab use in hepatocellular carcinoma (HCC) to our knowledge. We would like to introduce the case of a patient with Stage IV HCC who complained of abdominal pain, diarrhea and rectal bleeding after two cycles of atezolizumab/bevacizumab chemotherapy and was then diagnosed with UC-mimicking colitis. Endoscopy revealed typical findings of UC, suggesting diagnosis of UC-mimicking colitis. The patient was treated with systemic steroids and oral mesalamine, which significantly improved his symptoms, which were also supported by endoscopic findings. The patient resumed chemotherapy with atezolizumab and bevacizumab without any interruption to the chemotherapy schedule. Early endoscopic evaluation is pivotal to diagnosing UC-mimicking colitis. If diagnosed, UC-based treatments such as steroids and mesalamine should be strongly considered. Given previous reports of inflammatory bowel disease (IBD) flare-ups after immunotherapy, routine lower endoscopy, performed together with upper endoscopy before atezolizumab/bevacizumab therapy, is promising to patients.
免疫检查点抑制剂（ICI）结肠炎是 ICI 最常见和最严重的不良反应之一。然而，据我们所知，在 HCC 中使用阿替利珠单抗后，尚无溃疡性结肠炎（UC）样结肠炎的病例报告。我们想介绍一例 IV 期 HCC 患者的病例，该患者在接受阿替利珠单抗/贝伐珠单抗化疗两个周期后出现腹痛、腹泻和直肠出血，随后被诊断为 UC 样结肠炎。内镜检查显示出典型的 UC 表现，提示 UC 样结肠炎的诊断。该患者接受全身皮质类固醇和口服美沙拉嗪治疗，症状明显改善，内镜检查结果也支持这一诊断。患者在没有中断化疗方案的情况下恢复了阿替利珠单抗和贝伐珠单抗的化疗。早期内镜评估对诊断 UC 样结肠炎至关重要。如果诊断为 UC 样结肠炎，应强烈考虑基于 UC 的治疗方法，如皮质类固醇和美沙拉嗪。鉴于先前有免疫治疗后炎症性肠病（IBD）发作的报道，在接受阿替利珠单抗/贝伐珠单抗治疗前，联合进行上消化道内镜和下消化道内镜检查有望对患者有益。
