{"title":"Nivolumab-Induced Refractory Hemorrhagic Gastritis and Duodenitis Requiring Multimodal Biologic Therapy.","authors":"Roney Shibu, Kayla Scully, Waled Mohsen, Robert Mason, Sooraj Rajendran Pillai","doi":"10.14309/crj.0000000000001782","DOIUrl":null,"url":null,"abstract":"<p><p>Rising immune checkpoint inhibitor use in modern cancer therapy has increased the incidence of immune-related adverse events. Although isolated upper gastrointestinal immune-related adverse events including gastritis and duodenitis are uncommon, they may be severe and potentially life-threatening. The heterogeneous presentation of immune-related gastritis and duodenitis causes diagnostic and therapeutic challenges. We present a rare case of severe hemorrhagic gastritis and duodenitis occurring 2 months after completion of nivolumab therapy for stage III melanoma. The disease proved refractory to intravenous pantoprazole, steroids, and infliximab alone, ultimately requiring the addition of vedolizumab in the short term. Complete clinical and biochemical remission was achieved after 12 months of infliximab, which was ceased a month later. Following cessation of immunomodulatory therapy, there was no recurrence of disease at 12-month follow-up.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 8","pages":"e01782"},"PeriodicalIF":0.5000,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330355/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACG Case Reports Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14309/crj.0000000000001782","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Rising immune checkpoint inhibitor use in modern cancer therapy has increased the incidence of immune-related adverse events. Although isolated upper gastrointestinal immune-related adverse events including gastritis and duodenitis are uncommon, they may be severe and potentially life-threatening. The heterogeneous presentation of immune-related gastritis and duodenitis causes diagnostic and therapeutic challenges. We present a rare case of severe hemorrhagic gastritis and duodenitis occurring 2 months after completion of nivolumab therapy for stage III melanoma. The disease proved refractory to intravenous pantoprazole, steroids, and infliximab alone, ultimately requiring the addition of vedolizumab in the short term. Complete clinical and biochemical remission was achieved after 12 months of infliximab, which was ceased a month later. Following cessation of immunomodulatory therapy, there was no recurrence of disease at 12-month follow-up.
期刊介绍:
ACG Case Reports Journal is a peer-reviewed, open-access publication that provides GI and hepatology fellows, private practice clinicians, and other healthcare providers an opportunity to share interesting case reports with their peers and with leaders in the field. ACG Case Reports Journal publishes case reports, images, videos and letters to the editor in all topics of gastroenterology and hepatology, including: Biliary Colon Endoscopy Esophagus Functional Bowel Disorders Inflammatory Bowel Disease Liver Nutrition and Obesity Pancreas Pathology Pediatric Small Bowel Stomach.