Superimposed Clostridium difficile Infection During Checkpoint Inhibitor Immunotherapy-induced Colitis

J Immunother. 2019 Nov/Dec;42(9):350-353. doi: 10.1097/CJI.0000000000000270.

Abstract

Immunotherapy with checkpoint inhibitors (ICI) is widely used to treat a variety of neoplasms. ICI can induce an immune response against cancer; however, ICI can also induce autoimmunity, an undesirable side effect. Autoimmune colitis is one of the most well-known and troubling side effects of ICI. In this report, we described a series of 5 patients who developed ICI-induced colitis. During the course of this complication, all developed Clostridium difficile infection (CDI). This report described the course of the 2 medical conditions in these patients. On the basis of our experiences, CDI may occur as a superimposed infection during ICI-induced colitis. Although ICI-induced colitis may be a risk factor for CDI, the observed association may be fortuitous. Future study will be needed to characterize the association between CDI and ICI-induced colitis. Clinicians should be mindful of possible co-occurrence of both conditions to promptly and adequately institute effective interventions.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma / drug therapy
  • Adrenal Cortex Hormones / therapeutic use
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Antineoplastic Agents, Immunological / adverse effects*
  • Carcinoma, Large Cell / drug therapy
  • Clostridium Infections / drug therapy
  • Clostridium Infections / etiology*
  • Colitis / etiology*
  • Female
  • Humans
  • Immunotherapy / adverse effects*
  • Lung Neoplasms / drug therapy
  • Male
  • Metronidazole / therapeutic use
  • Middle Aged
  • Neuroendocrine Tumors / drug therapy

Substances

  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Antineoplastic Agents, Immunological
  • Metronidazole