From ICI to ICU: Ipilimumab and Nivolumab-Induced Immune Checkpoint Inhibitor Colitis

Excerpt

A 68-year-old man of European ancestry with a history of chronic kidney disease, diabetes, hypertension, and renal cell carcinoma (RCC) status post right nephrectomy (2017) was evaluated by the gastroenterology (GI) inpatient service for diarrhea in the setting of recent ipilimumab and nivolumab chemotherapy. He was first diagnosed with RCC three years prior to presentation, having undergone right nephrectomy for a 9 cm renal mass. Initially, though radiologic surveillance post-nephrectomy showed no evidence of recurrence with stable pulmonary nodules, repeat imaging one year after his nephrectomy revealed new right basilar pleural nodules concerning for metastasis for which he was treated with ipilimumab/nivolumab. One week before his third cycle (C3D1) of treatment, the patient developed four loose watery stools per day treated with prednisone 100 mg daily for 5 days, followed by a taper to 80 mg daily and imodium 2 mg as needed. Despite oral prednisone, his diarrhea continued, with resultant intravascular volume depletion requiring admission. …