A unique case of protein-losing enteropathy in the setting of immune checkpoint inhibition case report
Protein-losing enteropathy (PLE) is a well described entity, typically associated with autoimmune disorders such as Systemic Lupus Erythematosus (SLE). However, there is only one prior case reported on the association between PLE and the use of immune checkpoint inhibitors. We describe a case of PLE...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-09-01
|
| Series: | Current Problems in Cancer: Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666621923000364 |
| _version_ | 1797676575171280896 |
|---|---|
| author | Ezra Bernstein James Weinberger Avi Baskin Eesha Balar Victor Adorno Febles Arjun V. Balar |
| author_facet | Ezra Bernstein James Weinberger Avi Baskin Eesha Balar Victor Adorno Febles Arjun V. Balar |
| author_sort | Ezra Bernstein |
| collection | DOAJ |
| description | Protein-losing enteropathy (PLE) is a well described entity, typically associated with autoimmune disorders such as Systemic Lupus Erythematosus (SLE). However, there is only one prior case reported on the association between PLE and the use of immune checkpoint inhibitors. We describe a case of PLE presenting in a patient in their 70’s with muscle-invasive urothelial bladder cancer that developed while on treatment with pembrolizumab, radiation and gemcitabine for her cancer. The patient presented initially with progressive edema and hypoalbuminemia, and diffuse small bowel thickening on CT imaging without associated upper or lower gastrointestinal symptoms. Endoscopy with biopsy was performed demonstrating normal gastric and small bowel epithelium. A stool test for alpha-1-antitrypsin demonstrated increased clearance consistent with fecal protein loss and a diagnosis of PLE, presumed immune-related. She was promptly initiated on systemic corticosteroids with brisk resolution in her symptoms and normalization of serum albumin levels. Insights: This case highlights a rare immune-related adverse event, PLE, that should be considered in patients who develop hypoalbuminemia and its clinical sequelae after immune checkpoint inhibition therapy without evidence of colitis. |
| first_indexed | 2024-03-11T22:31:12Z |
| format | Article |
| id | doaj.art-bda28ce676ee4681833a088a9a143989 |
| institution | Directory Open Access Journal |
| issn | 2666-6219 |
| language | English |
| last_indexed | 2024-03-11T22:31:12Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Current Problems in Cancer: Case Reports |
| spelling | doaj.art-bda28ce676ee4681833a088a9a1439892023-09-23T05:12:51ZengElsevierCurrent Problems in Cancer: Case Reports2666-62192023-09-0111100252A unique case of protein-losing enteropathy in the setting of immune checkpoint inhibition case reportEzra Bernstein0James Weinberger1Avi Baskin2Eesha Balar3Victor Adorno Febles4Arjun V. Balar5NYU Langone Health, New York, NY, USA; Corresponding author at: 200 West 26th St Apt 12I NY, NY 10001, USA.Department of Urology, UCLA, Los Angeles, CA, USADepartment of Urology, UCSF, San Francisco, CA, USAThe University of Pennsylvania, Philadelphia, PA, USAGenitourinary Medical Oncology Program, Laura and Isaac Perlmutter Cancer Center, New York, NY, USAGenitourinary Medical Oncology Program, Laura and Isaac Perlmutter Cancer Center, New York, NY, USAProtein-losing enteropathy (PLE) is a well described entity, typically associated with autoimmune disorders such as Systemic Lupus Erythematosus (SLE). However, there is only one prior case reported on the association between PLE and the use of immune checkpoint inhibitors. We describe a case of PLE presenting in a patient in their 70’s with muscle-invasive urothelial bladder cancer that developed while on treatment with pembrolizumab, radiation and gemcitabine for her cancer. The patient presented initially with progressive edema and hypoalbuminemia, and diffuse small bowel thickening on CT imaging without associated upper or lower gastrointestinal symptoms. Endoscopy with biopsy was performed demonstrating normal gastric and small bowel epithelium. A stool test for alpha-1-antitrypsin demonstrated increased clearance consistent with fecal protein loss and a diagnosis of PLE, presumed immune-related. She was promptly initiated on systemic corticosteroids with brisk resolution in her symptoms and normalization of serum albumin levels. Insights: This case highlights a rare immune-related adverse event, PLE, that should be considered in patients who develop hypoalbuminemia and its clinical sequelae after immune checkpoint inhibition therapy without evidence of colitis.http://www.sciencedirect.com/science/article/pii/S2666621923000364ImmunotherapyUrothelial cancerPembrolizumab |
| spellingShingle | Ezra Bernstein James Weinberger Avi Baskin Eesha Balar Victor Adorno Febles Arjun V. Balar A unique case of protein-losing enteropathy in the setting of immune checkpoint inhibition case report Current Problems in Cancer: Case Reports Immunotherapy Urothelial cancer Pembrolizumab |
| title | A unique case of protein-losing enteropathy in the setting of immune checkpoint inhibition case report |
| title_full | A unique case of protein-losing enteropathy in the setting of immune checkpoint inhibition case report |
| title_fullStr | A unique case of protein-losing enteropathy in the setting of immune checkpoint inhibition case report |
| title_full_unstemmed | A unique case of protein-losing enteropathy in the setting of immune checkpoint inhibition case report |
| title_short | A unique case of protein-losing enteropathy in the setting of immune checkpoint inhibition case report |
| title_sort | unique case of protein losing enteropathy in the setting of immune checkpoint inhibition case report |
| topic | Immunotherapy Urothelial cancer Pembrolizumab |
| url | http://www.sciencedirect.com/science/article/pii/S2666621923000364 |
| work_keys_str_mv | AT ezrabernstein auniquecaseofproteinlosingenteropathyinthesettingofimmunecheckpointinhibitioncasereport AT jamesweinberger auniquecaseofproteinlosingenteropathyinthesettingofimmunecheckpointinhibitioncasereport AT avibaskin auniquecaseofproteinlosingenteropathyinthesettingofimmunecheckpointinhibitioncasereport AT eeshabalar auniquecaseofproteinlosingenteropathyinthesettingofimmunecheckpointinhibitioncasereport AT victoradornofebles auniquecaseofproteinlosingenteropathyinthesettingofimmunecheckpointinhibitioncasereport AT arjunvbalar auniquecaseofproteinlosingenteropathyinthesettingofimmunecheckpointinhibitioncasereport AT ezrabernstein uniquecaseofproteinlosingenteropathyinthesettingofimmunecheckpointinhibitioncasereport AT jamesweinberger uniquecaseofproteinlosingenteropathyinthesettingofimmunecheckpointinhibitioncasereport AT avibaskin uniquecaseofproteinlosingenteropathyinthesettingofimmunecheckpointinhibitioncasereport AT eeshabalar uniquecaseofproteinlosingenteropathyinthesettingofimmunecheckpointinhibitioncasereport AT victoradornofebles uniquecaseofproteinlosingenteropathyinthesettingofimmunecheckpointinhibitioncasereport AT arjunvbalar uniquecaseofproteinlosingenteropathyinthesettingofimmunecheckpointinhibitioncasereport |