The immune-associated gastritis patient was successfully rescued in the first ward of the Department of Gastroenterology of Nanyang Central Hospital
Immunotherapy of tumors is currently a hot research topic in the field of anti-tumor. Immunotherapy may cause a series of immune-related adverse reactions while achieving significant efficacy, which can affect various systems throughout the patient's body.
Recently, nanyang central hospital gastroenterology department ward 1 successfully admitted a case of paporizumab caused by immune-related gastritis patients. The patient is a 58-year-old woman who used "Pemelisel" chemotherapy combined with "Pabrilizumab" immunotherapy for lung cancer for 12 cycles 12 years ago, and after taking the drug, she developed diarrhea, watery stools, epigastric vague pain and discomfort, heartburn and nausea. After treatment in other hospitals, the patient's abdominal pain is less severe, but he still vomits blood, frequent nausea, and fever.
After the patient was transferred to the hospital, the patient's body temperature was 38 ° C when admitted, poor spirits, frequent nausea, and vomiting a small amount of dark red blood. After admission, drug treatment such as "Vonorasin and Esomeprazole" was given, and the patient did not vomit blood again, his mental condition improved, and he still intermittently nausea and vomiting. 10.20 Perfect gastroscopy: extensive congestion and edema of the gastric anguscosa mucosa of the gastric floor of the stomach body, extensive flat erosion, partially covered with white moss, brittle touch easy to bleed, like gastric mucosa peeling, mucus paste coffee color. After gastroscopy, continue to give acid-suppressing drugs such as "Vonorasin, Eprazole" in accordance with acute erosion hemorrhagic gastritis, the patient did not vomit blood and abdominal pain, but still intermittently nausea, vomiting, still fever, more than in the afternoon, hot peak 38.6 ° C, during the check of three blood cultures, tuberculosis-specific cytokines, respiratory nine joint tests, G test, GM test, antinuclear antibody spectrum, etc. there are no obvious abnormalities, 11.05 re-examination gastroscope: gastric body gastric body gastral mucosa is extensively congested and edematous, extensive flat erosion, partially covered with white lichen, Fragile to the touch is easy to bleed, the antrucillary cavity is narrowed, and the endoscope cannot pass.
Patients who have completed a variety of tests, cannot explain gastric mucosal changes and fever with common diseases, and have poor efficacy in treatment of general erosive hemorrhagic gastritis, combined with medical history, consider that pabrizulizumab causes immune-associated gastritis. After full communication with the patient and his or her family, refer to the Guidelines for the Administration of Toxicity Related to Immune Checkpoint Inhibitors 2019 for hormonal therapy. 11.11 Administer methylprednisolone sodium succinate 40mg intravenously every 12 hours, and after 5 days of continuous use, nausea and vomiting are significantly relieved, eating is increased, and there is no fever. Adjust the dose of methylprednisolone sodium succinate to 20mg every 12 hours intravenous injection once, after 1 day of application to change to oral methylbonisolone tablets, from the initial amount of 32mg / day, according to 3 days to reduce the amount of 4mg gradually stop the hormone, now the patient is no longer nausea, vomiting, hematemesis, fever, 12.08 re-examination of the gastrosoptic floor, the gastric mucosa basically returned to normal, the gastric ancillary mucosa still has erosions, the stenosis of the gastric sinuses is significantly reduced, the endoscope can be passed, the patient's gastric mucosal abnormalities are effectively treated by hormones, nausea, fever and other symptoms are alleviated, Further validation of the diagnosis of immune-associated gastritis.
At present, immunotherapy has played an important role in the treatment of a variety of tumors, in immunotherapy, immune-related gastrointestinal toxicity is not uncommon, but mostly involves sigmoid colon and rectum, upper gastrointestinal changes are rare, abdominal pain, diarrhea, gastrointestinal bleeding and other symptoms, should be vigilant about immune-related gastrointestinal toxicity may be, in immunotherapy should pay close attention to the occurrence of immune-related adverse reactions, early diagnosis, early treatment.
Source: Nanyang Central Hospital
