title: Ipilimumab-induced colonic perforation.
abstract: Biologic immune modulators such as ipilimumab have demonstrated the efficacy against metastatic melanoma. We present a recent case of a 52-year-old male who initially developed mild colitis following the initiation of ipilimumab treatment for metastatic melanoma. Despite initial improvement with immediate cessation of drug and initiation of high-dose steroid therapy his clinical condition worsened and the patient presented to our facility in extremis from colonic perforation. Following an extended right hemicolectomy his postoperative period was extended due to continued symptomatic enteritis. After 3 weeks colonoscopy revealed that the autoimmune event had begun to subside;  his condition improved, resulting in discharge. We discuss this particular side effect with respect to ipilimumab adjuvant therapy in melanoma.
authors.affiliation: Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA ljburdine@uams.edu.
authors.forename: Lyle
authors.initials: L
authors.lastname: Burdine
authors.affiliation: Department of Pathology, University of Arkansas for Medical Sciences, University of Arkansas, Little Rock, AR, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Lai
authors.affiliation: Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Laryea