ABSTRACT
Immune checkpoint inhibitors (ICI) reinvigorate the immune system to recognize and destroy tumor cells. Because of this biological mechanism, patients might develop autoimmune toxicities, notably in the digestive tract (most frequently, hepatitis or colitis). A 70-year-old man with relapsed mesothelioma was treated with nivolumab in 3rd line. He was hospitalized for watery and foul-smelling diarrhea. He underwent gastrointestinal endoscopy, showing duodenitis and villous atrophy and measurement of serum IgA antibodies to tissue transglutaminase (tTG-IgA+), leading to the diagnosis of ICI-induced celiac disease. He was treated with steroids, proton pump inhibitors, and a gluten-free diet. If ICI-induced celiac disease is rare in the literature, increasing reports suggest that celiac disease might represent an underestimated ICI toxicity. This case highlights the necessity of complementary investigation (including tTG-IgA and endoscopic biopsies) in patients with atypical digestive symptoms during immunotherapy.
Subject(s)
Celiac Disease/chemically induced , Immune Checkpoint Inhibitors/adverse effects , Mesothelioma/drug therapy , Nivolumab/adverse effects , Pleural Neoplasms/drug therapy , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Aged , Autoantibodies/blood , Celiac Disease/diagnosis , Celiac Disease/immunology , Celiac Disease/therapy , Diet, Gluten-Free , Glucocorticoids/therapeutic use , Humans , Immunoglobulin A/blood , Male , Mesothelioma/immunology , Pleural Neoplasms/immunology , Programmed Cell Death 1 Receptor/immunology , Protein Glutamine gamma Glutamyltransferase 2/immunology , Proton Pump Inhibitors/therapeutic use , Treatment OutcomeABSTRACT
This case report describes a 62-year-old female patient developing a granulomatous sarcoidosis-like reaction in mediastinal lymphatic nodes during a treatment by palbociclib for a metastatic breast carcinoma. After a 3-month treatment associating palbociclib, anastrozole, denosumab, and a single targeted cervical vertebral metastasis radiation therapy, a positron emission tomography showed full regression of breast, vertebral, and axillary node lesion contrasting to new emergent metabolic mediastinal lymph nodes. An endobronchial ultrasound-guided transbronchial needle aspiration revealed a sarcoidosis-like reaction, which dramatically decreased with glucocorticoids.
