Immune checkpoint inhibitor-induced colitis complicated with inflammatory intestinal obstruction: a case report and literature review.

BACKGROUND

The combination therapy using anti-angiogenic drugs and immune checkpoint inhibitors (ICIs) has an excellent safety profile and manageable toxicity. However, ICI therapy may lead to a variety of autoimmune events, known as immune-related adverse events (irAEs), which some secondary complications may occur, such as immune-mediated colitis (IMC) and secondary inflammatory intestinal obstruction. It could impact clinical assessments and treatment decisions. Although there are few reports about secondary inflammatory intestinal obstruction related IMC.

CASE DESCRIPTION: We report an adult patient who suffered from primary liver cancer, who accepted ICIs (sintilimab) combined with vascular endothelial growth factor (VEGF) inhibitor (bevacizumab). He suffered worsening diarrhea about 5 days following immunotherapy. Computed tomography (CT) revealed the thickening intestinal wall of colon and rectum and massive cerebral gas in the proximal colon cavity. He was hospitalized with a diagnosis of IMC and inflammatory intestinal obstruction. Finally, he underwent the therapeutic option using combined glucocorticoid and somatostatin. His symptoms eased within 3 weeks and he was discharged from the hospital.

CONCLUSIONS

IMC with diarrhea as the main manifestation requires early diagnosis and timely treatment. If the condition progresses, inflammatory intestinal obstruction may occur and this is a life-threatening situation. It is effective to accept early glucocorticoid and somatostatin while casual surgery may aggravate intestinal inflammation and injury, even death.