title: Ipilimumab-associated colitis or refractory Clostridium difficile infection?
abstract: We present a case of a patient with a diagnostic dilemma who was referred for possible faecal microbiota transplantation (FMT) for refractory diarrhoea secondary to Clostridium difficile infection (CDI). On detailed history, the patient was exposed to ipilimumab concomitantly while being treated for CDI, and was instead diagnosed with diarrhoea secondary to superimposed ipilimumab-associated colitis. Ipilimumab is an anti-CTLA4 monoclonal antibody approved for use in metastatic melanoma and under trial for other indications. Ipilimumab is associated with several immune-related adverse effects, of which diarrhoea and colitis are the most common. While FMT has shown tremendous efficacy in managing recurrent and refractory CDI, it was not offered in this case due to negative C. difficile testing showing a high degree of suspicion for ipilimumab-associated colitis due to recent drug use. Our patient was successfully managed with fluid resuscitation and steroids, and remains symptom free at last follow-up at 9 months.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Arjun
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sahil
authors.initials: S
authors.lastname: Khanna
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D016360:Clostridioides difficile / Q000187:drug effects*; D003092:Colitis / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy*; D003967:Diarrhea / Q000188:drug therapy / Q000209:etiology*; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000188:drug therapy*; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D000074324:Ipilimumab; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000074324:Ipilimumab; D008775:Methylprednisolone