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Nivolumab-associated active neutrophilic gastritis
  1. Laura Rovedatti1,
  2. Marco Vincenzo Lenti1,
  3. Alessandro Vanoli2,
  4. Monica Feltri2,
  5. Federico De Grazia1,
  6. Antonio Di Sabatino1
  1. 1First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
  2. 2Unit of Pathology, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  1. Correspondence to Dr Laura Rovedatti, First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy; l.rovedatti{at}smatteo.pv.it

https://doi.org/10.1136/jclinpath-2020-206540

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    In recent years, the increasing use of immune checkpoint inhibitors for the treatment of multiple metastatic malignancies has revealed a wide spectrum of immune-related adverse events (irAEs), many of which are managed by the gastroenterologist.1–3

    Among all gastrointestinal (GI)-irAEs, while colitis has been extensively described, gastritis has only been sporadically reported.3–5

    We here describe the endoscopic and histopathological features of an acute nivolumab-induced gastritis, before and after oral corticosteroid therapy.

    A 57-year-old woman, affected by metastatic clear cell renal carcinoma treated with twelve cycles of nivolumab with complete response, had epigastric pain and loss of appetite. She underwent an upper gastrointestinal endoscopy (UGIE) which revealed diffuse, geographical ulcerations covered with whitish fibrin-like membranes, with surrounding erythematous friable mucosa (figure 1). Oesophagus and duodenum were macroscopically normal. In both antrum and corpus biopsies, histology showed a chronic active Helicobacter pylori- …

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    Footnotes

    • Handling editor Runjan Chetty.

    • Contributors All authors significantly participated in the drafting of the manuscript or critical revision of the manuscript for important intellectual content and provided approval of the final submitted version. Individual contributions are as follow: LR and MVL wrote the manuscript and interpreted data. FDG and LR performed the endoscopy, provided the images. AV and MF provided histopathological specimen. ADS made final critical revision for important intellectual contents. All authors reviewed the paper for final approval.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.