Acute neutrophilic gastritis induced by nivolumab used as a treatment of non- metastatic malignant melanoma

We present a 47 year-old man with a personal history of malignant melanoma (pT3bN2M0) radically removed, who was receiving adjuvant Nivolumab for prevention of recurrence. He was admitted to our service complaining of epigastric pain and hyporexia after receiving the 9º dose of Nivolumab. He underwent a preferential esophagogastroduodenoscopy which showed an intense inflammation limited to the stomach. Macroscopically all the mucosa was erythematosus, edematous, with friability and large ulcerations covered with fibrin. Multiple biopsies revealed inflammatory neutrophilic infiltration in the epithelium, cellular apoptosis and crypt microabscesses, all of which was related to Nivolumab drug-induced pangastritis. No form of Helicobacter Pylori was identified. A medical treatment with double dose of proton-pump inhibitor and definitive cessation of Nivolumab was established, becoming the patient rapidly asymptomatic. The immune checkpoint inhibitors are becoming a widespread treatment in the Oncology field. Nivolumab is a PD-L1 inhibitor, leading to the activation of the cytotoxic immune response carried out by LT-CD8 (1). Despite the immune-mediated adverse events related to the lower gastrointestinal tract are well known; the gastritis or the esophagitis remain sporadic effects (2). They can appear several months after the beginning of the treatment but also after its discontinuation. The differential diagnosis must be reached by excluding pathologies such as infectious g...
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Authors: Source Type: research

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