A Celiac Disease Phenotype After Checkpoint Inhibitor Exposure: An Example of Immune Dysregulation After Immunotherapy. Issue 8 (8th August 2019)

• Record Type: Journal Article
• Authors: Arnouk, Joud; Mathew, Don; Nulton, Ethan; Rachakonda, Vikrant
• Is Part Of: ACG Case Reports Journal. Volume 6:Issue 8(2019)
• Page Start: e00158
• Publication Date: 2019-08-08
• DOI: 10.14309/crj.0000000000000158
• Languages: English
• ISSNs: 2326-3253

Abstract

ABSTRACT: Celiac disease is characterized by duodenal inflammation after exposure to gluten. Checkpoint inhibitors are antibodies that inhibit the inhibitory signals of the cytotoxic T lymphocytes to enhance antitumor responses. A 79-year-old man with an unknown history of celiac disease underwent treatment with pembrolizumab for recurrent left maxillary melanoma. He subsequently developed diarrhea and weight loss. Serology was positive for anti-tissue transglutaminase immunoglobulin A. Upper endoscopy revealed duodenal villous atrophy, which was confirmed on biopsy. A gluten-free diet was not tolerated, and symptoms resolved with withdrawal of pembrolizumab and steroid administration for another medical reason.