Development of Celiac Disease After Immunotherapy: A Case Series.

BACKGROUND AND AIMS: Celiac disease results from a complex immune response to gluten in genetically susceptible individuals. It has been noted to occur with immune checkpoint inhibitor therapies and other novel therapies in prior case reports. In this case series, we report 3 cases of celiac disease in patients receiving therapy for psoriasis, breast cancer, and renal cell carcinoma.

METHODS

Three cases of celiac disease occurring in patients after novel medications were identified by gastroenterologists at a tertiary care center. Informed consent was obtained from all 3 patients. Medical history and clinical data were obtained by review of the electronic medical record.

RESULTS

Celiac disease developed in 3 patients after initiating biologic therapy: a 21-year-old female with psoriasis receiving ixekizumab (interleukin-17 antagonist) and risankizumab (interleukin-23 antagonist); a 49-year-old female with invasive ductal carcinoma of the breast after pertuzumab (human epidermal growth factor receptor 2 antagonist); and an 82-year-old male taking cabozantinib (multityrosine kinase inhibitor) for renal cell carcinoma.

CONCLUSION

We have identified 3 cases of celiac disease that presented after initiating new immune-modulating medications. It is important to consider celiac disease and nonceliac villous atrophy in the differential for diarrhea developing during or after a new therapy as it heavily impacts management and may eliminate the need for alternate therapies that include steroid courses, cessation of therapy, or even gluten-free diet.