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• W2184367009 abstract "We read with interest the paper by Gupta et al.1 and we would like to report the case of a patient developing bloody diarrhoea after treatment with ipilimumab for metastatic melanoma. Ipilimumab is an anti-cytotoxic T-lymphocyte-Associated Protein-4 (CTLA-4) agent, effective in the treatment of metastatic melanoma.2 It works by prolonging T-cell activation, resulting in augmented host T-cell immunity and sustained immune response against tumour cells due to loss of tolerance. This immune dysregulation is associated with several immune-related adverse events including dermatitis, endocrinopathies, uveitis, hepatitis and colitis.3 In the study of Hodi et al.2, the overall incidence of immune-related ipilimumab-associated colitis with diarrhoea was 28–30%. In Ipilimumab-treated patients with diarrhoea, stool tests for enteric pathogens and exclusion of Clostridium difficile infection is mandatory, because ipilimumab-associated colitis and infection can coexist.1 Once stool infection is excluded, the first choice therapy is glucocorticosteroids, and in refractory patients, infliximab. We report the case of a patient with cutaneous metastasis from melanoma treated with ipilimumab (three infusions at a dosage of 3 mg/kg) who developed initially a watery, and then bloody, diarrhoea after the third infusion. He was urgently admitted to the oncology department where an infectious colitis (stool cultures positive for Campylobacter and Candida albicans) was detected, and metronidazole and levofloxacin commenced, along with oral prednisone (75 mg/day), but without benefit. Sigmoidoscopy demonstrated a severe colitis with deep ulcers (Figure 1) confirmed by microscopic findings that showed necrotic material and granulation tissue, in which scattered large epithelial perivascular cells and histiocytes exhibiting eosinophilic intra-nuclear inclusion bodies, strongly immuno-reactive for anti-cytomegalovirus (CMV) antibody. High levels of CMV DNA (87 380 copies/mL) were found in the serum. Intravenous ganciclovir 5 mg/kg b.d. was started with slow clinical improvement. After 2 weeks of therapy, the patient was well with two to three bowel movements per day without blood and a repeat sigmoidoscopy revealed no ulcers. CMV DNA levels were reduced. Only one other case of CMV infection, with acute hepatitis, in a patient treated with ipilimumab has been reported in the literature to date.4 Ipilimumab is an immune-stimulatory agent frequently associated with immune-mediated reactions that require significant immunosuppressive therapy, placing these patients at risk for opportunistic infections. In conclusion, we suggest excluding CMV infection in all patients with ipilimumab-induced glucocorticosteroid-refractory colitis before starting more aggressive treatments, such as infliximab. Declaration of personal and funding interests: None." @default.
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• W2184367009 date "2015-12-06" @default.
• W2184367009 modified "2023-09-25" @default.
• W2184367009 title "Letter: cytomegalovirus colitis in a patient treated with ipilimumab for metastatic melanoma" @default.
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• W2184367009 doi "https://doi.org/10.1111/apt.13451" @default.
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