Open AccessA Celiac Disease Phenotype After Checkpoint Inhibitor Exposure: An Example of Immune Dysregulation After Immunotherapy
Author(s) -
Joud Arnouk,
Don Mathew,
Ethan Nulton,
Vikrant Rachakonda
Publication year - 2019
Publication title -
acg case reports journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.112
H-Index - 4
ISSN - 2326-3253
DOI - 10.14309/crj.0000000000000158
Subject(s) - medicine , pembrolizumab , immunology , cytotoxic t cell , gluten free , tissue transglutaminase , antibody , atrophy , biopsy , villous atrophy , immunotherapy , disease , immune system , gastroenterology , coeliac disease , in vitro , enzyme , biochemistry , chemistry
Celiac disease is characterized by duodenal inflammation after exposure to gluten. Checkpoint inhibitors are antibodies that inhibit the inhibitory signals of the cytotoxic T lymphocytes to enhance antitumor responses. A 79-year-old man with an unknown history of celiac disease underwent treatment with pembrolizumab for recurrent left maxillary melanoma. He subsequently developed diarrhea and weight loss. Serology was positive for anti-tissue transglutaminase immunoglobulin A. Upper endoscopy revealed duodenal villous atrophy, which was confirmed on biopsy. A gluten-free diet was not tolerated, and symptoms resolved with withdrawal of pembrolizumab and steroid administration for another medical reason.