title: A severe case of ipilimumab-induced guillain-barré syndrome revealed by an occlusive enteric neuropathy: a differential diagnosis for ipilimumab-induced colitis.
abstract: Ipilimumab is a fully human monoclonal antibody directed against cytotoxic T-lymphocyte antigen-4 recently approved for the treatment of metastatic melanoma and currently under investigation in the adjuvant setting of high-risk stage III melanoma. The blockade of CTLA-4 induces activation of T cells, with an expected increase in the immunological reaction directed to cancer. We report a case of ipilimumab-induced Guillain-Barré syndrome revealed by an occlusive enteric neuropathy. Two weeks after the second dose of ipilimumab, our patient started to complain of abdominal meteorism and nausea. Within a few days, an occlusive syndrome developed. Wall biopsies during colonoscopy revealed a slight edema of the mucosa and a high number of lymphocytic follicles, leading to the diagnosis of ipilimumab-induced immune colitis. A respiratory failure occurred and a neurological deficiency developed rapidly. The diagnosis of polyradiculoneuritis was retained. Despite IV steroids, tacrolimus than plasmatic exchanges, the patient died within a few days because of multivisceral failure. Polyradiculoneuritis is a rare but very severe immune-mediated complication of ipilimumab. Occlusive enteric neuropathy may mimic the digestive symptoms of colitis, which is so frequent under ipilimumab.
authors.affiliation: Department of Dermatology, APHM, Hopital Timone, Aix-Marseille University, Marseille, France. gaudy@ap-hm.fr
authors.forename: Caroline
authors.initials: C
authors.lastname: Gaudy-Marqueste
authors.forename: Sandrine
authors.initials: S
authors.lastname: Monestier
authors.forename: Jérome
authors.initials: J
authors.lastname: Franques
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cantais
authors.forename: Marie-Aleth
authors.initials: MA
authors.lastname: Richard
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Grob
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003092:Colitis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D020275:Guillain-Barre Syndrome / Q000139:chemically induced* / Q000175:diagnosis*; D006801:Humans; D000074324:Ipilimumab; D008297:Male; D008545:Melanoma / Q000188:drug therapy; D012878:Skin Neoplasms / Q000188:drug therapy
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000074324:Ipilimumab