Severe steroid refractory gastritis induced by Nivolumab: A case report

World J Gastroenterol. 2020 Apr 28;26(16):1971-1978. doi: 10.3748/wjg.v26.i16.1971.

Abstract

Background: Immune checkpoint inhibitors are widely used for treatment of many advanced malignancies. Lower gastrointestinal (GI) side effects, such as diarrhea and colitis, are common, but upper GI side effects are rarely reported. Consequently, the correct treatment of upper GI adverse events has been less frequently described.

Case summary: We describe a case of a 16-year-old woman with stage IIIb malignant melanoma treated with adjuvant monotherapy using Nivolumab. The patient developed severe gastritis after six series of Nivolumab with weight loss, nausea, and vomiting. There was no effect of intravenous steroids, but the patient´s condition resolved after administration of Infliximab.

Conclusion: This case report supports the same treatment for gastritis as for colitis, which is in line with current guidelines.

Keywords: Case report; Gastritis; Immune checkpoint inhibitors; Immune-related adverse events; Infliximab; Nivolumab.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Chemotherapy, Adjuvant / adverse effects
  • Chemotherapy, Adjuvant / methods
  • Drug Resistance
  • Female
  • Gastritis / diagnosis
  • Gastritis / drug therapy
  • Gastritis / immunology*
  • Glucocorticoids / pharmacology*
  • Glucocorticoids / therapeutic use
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects*
  • Infliximab / therapeutic use*
  • Melanoma / immunology
  • Melanoma / therapy
  • Nivolumab / adverse effects*
  • Severity of Illness Index
  • Skin Neoplasms / immunology
  • Skin Neoplasms / therapy
  • Treatment Outcome

Substances

  • Glucocorticoids
  • Immune Checkpoint Inhibitors
  • Nivolumab
  • Infliximab