000			03862nam a22005897a 4500
008			190823s20192019 xxu||||| |||| 00| 0 eng d
022			_a2051-1426
024			_a10.1186/s40425-019-0694-x [doi]
024			_a10.1186/s40425-019-0694-x [pii]
040			_aOvid MEDLINE(R)
099			_a31383006
245			_aA case of checkpoint inhibitor-induced celiac disease.
251			_aJournal for Immunotherapy of Cancer. 7(1):203, 2019 08 05.
252			_aJ Immunother Cancer. 7(1):203, 2019 08 05.
252			_zJ Immunother Cancer. 7(1):203, 2019 Aug 05.
253			_aJournal for immunotherapy of cancer
260			_c2019
260			_fFY2020
265			_sepublish
266			_d2019-08-23
268			_aJournal for Immunotherapy of Cancer. 7(1):203, 2019 Aug 05.
520			_aBACKGROUND: Immune checkpoint inhibitors (ICIs) have now become standard of care treatment for many malignancies. ICIs are associated with unique immune mediated adverse events (irAEs) due to dysregulation of immune activation. As treatment with ICIs is becoming more common, rare irAEs are also being recognized. Here we report a case of ICI-induced celiac disease.
520			_aCASE: A 74-year-old Caucasian female with metastatic renal carcinoma received second line nivolumab (anti-PD1 antibody) after initial disease progression on sunitinib. Ipilimumab was added after she failed to respond to six cycles of nivolumab monotherapy. One week after her first cycle of combination treatment, she presented with nausea, vomiting, grade 1 diarrhea, and weight loss. She underwent endoscopy, which showed bile stasis in the stomach, normal appearing stomach mucosa, and nonbleeding erythematous mucosa in the duodenal bulb. Stomach biopsy showed moderate active chronic gastritis. Duodenal biopsy showed moderate chronic active duodenitis with focal neutrophilic cryptitis, mucosal erosions, villous atrophy, mildly increased intraepithelial lymphocytes, and moderate chronic inflammation in the lamina propria pathognomonic of celiac disease. Symptoms improved with gluten-free diet, twice-daily omeprazole and anti-emetics and she was able to continue on treatment.
520			_aCONCLUSIONS: There has been only one published case reporting ICI-induced celiac disease. Our case report highlights a rare irAE (celiac disease) associated with ICI treatment. It is unclear whether the patient had previously undiagnosed celiac disease or whether ICIs triggered her enteritis. Our patient was able to continue treatment with ICIs with dietary modifications, suggesting correct diagnosis is critical for optimal patient outcome.
546			_aEnglish
650			_a*Antineoplastic Agents, Immunological/ae [Adverse Effects]
650			_a*Celiac Disease/et [Etiology]
650			_a*Neoplasms/co [Complications]
650			_aAged
650			_aAntineoplastic Agents, Immunological/tu [Therapeutic Use]
650			_aBiomarkers
650			_aBiopsy
650			_aCeliac Disease/di [Diagnosis]
650			_aEndoscopy, Gastrointestinal
650			_aFemale
650			_aHumans
650			_aImmunohistochemistry
650			_aIntestinal Mucosa/me [Metabolism]
650			_aIntestinal Mucosa/pa [Pathology]
650			_aMolecular Targeted Therapy/ae [Adverse Effects]
650			_aNeoplasms/dt [Drug Therapy]
650			_aNivolumab/ae [Adverse Effects]
650			_aNivolumab/tu [Therapeutic Use]
650			_aProgrammed Cell Death 1 Receptor/ai [Antagonists & Inhibitors]
651			_aMedStar Washington Hospital Center
656			_aMedicine/Internal Medicine
657			_aJournal Article
700			_aAlsaadi, Dana
790			_aAlsaadi D, Atkins MB, Charabaty A, Shah NJ
856			_uhttps://dx.doi.org/10.1186/s40425-019-0694-x _zhttps://dx.doi.org/10.1186/s40425-019-0694-x
942			_cART _dArticle
999			_c4504 _d4504