PMC9792950_01
Chest X-ray on initial diagnosis revealed a primary mass in the lower lung field of the right lung (A). Chest computed tomography was performed at the following time points: (B) on initial diagnosis, (F) after concurrent radiotherapy plus chemotherapy, and (G) on recurrence. 18-Labeled fluorodeoxyglucose (FDG) positron emission tomography on initial diagnosis revealed abnormal accumulation of FDG in the right lower lobe mass (C) and hilar (D) and mediastinal lymph node (E). FDG positron emission tomography performed at recurrence revealed abnormal accumulation of FDG in the right lower lobe mass (H).
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A-E). After two cycles of treatment, the tumor was confirmed to exhibit complete response according to the response evaluation criteria in solid tumors (Fig. 1F).
Clinical course of the present case.. mPSL, methylprednisolone; PSL, prednisolone; GCV, ganciclovir; TCS, total colonoscopy.
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The clinical course after admission is presented in Fig. 2.
Endoscopic evaluation revealed ICI-related colitis complicated by CMV infection. The entire colon exhibited diffuse severe inflammation characterized by adherent blood, erosion, erythema, and confluent ulcerations throughout the entire colon (A). Findings from the resected specimen (B) indicated multiple ulcerations. Histological examination of the resected specimen revealed crypt abscess and inflammatory cell infiltration (hematoxylin and eosin staining) (C and D). Scale bar, 100 mum. Immunohistochemistry for cytomegalovirus revealed a positive result (E and F). Scale bar, 100 mum.. CMV: Cytomegalovirus, ICI: immune checkpoint inhibitor.
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A colonoscopy revealed diffuse severe inflammation characterized by adherent blood, erosions, erythema, friability, and confluent ulcerations throughout the entire colon (Fig. 3A). An emergent subtotal colectomy followed by ileostomy was performed and findings from the resected specimen revealed diffuse confluent ulcerations throughout the entire colon (Fig. 3B). Specimens from the colon revealed crypt abscess with highly infiltrative plasma cells and lymphocytes (Fig. 3C and D), and immunohistochemical staining of colon biopsy specimen showed positivity for CMV (Fig. 3E and F).