A Case of ImmuneMediated Colitis Dr Amalia Stavropoulos IMT1 Dr Marios Decatris Cons Case Presentation A 61yearold woman with recurrent malignant melanoma Currently undergoing combination ICItherapy ID: 1044303
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1. Adverse Effects of Immune Checkpoint Inhibitors: A Case of Immune-Mediated ColitisDr. Amalia Stavropoulos (IMT1)Dr. Marios Decatris (Cons)
2. Case PresentationA 61-year-old woman with recurrent malignant melanomaCurrently undergoing combination ICI-therapy:Ipilimumab NivolumabHistory:Suffered several immune-mediated side effectsTwo recent admissions for Grade 2 ICI-mediated diarrhoeaPresents with:3-day history of 10 loose bowel motions daily
3. Investigations
4. ManagementGradeDefinitionManagementGrade 1(Mild)< 4 liquid stools per day above baselineSymptomatic treatment (Loperamide, electrolyte replacement, oral fluids)Continue ICI therapyGrade 2(Moderate)4-6 liquid stools per day above baseline+/- blood or mucus in stool +/- abdominal pain+/- nocturnal symptomsSymptomatic treatment (as above)Oral corticosteroidsWithhold ICI therapyGrade 3/Grade 4(Severe)≥ 7 liquid stools per day above baseline or Life threatening signs (peritoneal signs, fever, ileus, consistent with bowel perforation)Admission to hospitalIV Methylprednisolone (1-2 mg/kg once daily)Involve Gastroenterology Sigmoidoscopy/colonoscopyIV Infliximab (5 mg/kg)Consider permanent discontinuation of ICI therapy
5. ManagementClinical LessonsImmune-related adverse events (IRAEs) are commonTreatment of immune-mediated colitis (IMC) consists of:supportive measureshigh dose corticosteroidsEndoscopy should be considered in Grade 3/4 colitis.Refractory cases should be managed with:InfliximabGastroenterology involvement An MDT-based approach is key to the best possible outcome in such cases
6. AcknowledgementsI would like to thank: The Patient Dr M. Decatris Gastroenterology colleagues