PMC10331137_01
Clinical features of the patient during hospitalization. (A). Temperature during hospitalization (Celsius). (B). CRP levels during hospitalization. (C). Biopsies, anti-inflammatory drugs and antimicrobials during hospitalization. (D). Defecation frequency during hospitalization. (E, F). Representative images of sigmoidoscopies at (E) day 16 and (F) day 51. (G). PET-CT at day 48 with FDG-uptake in the colon. (H). PET-CT 3 months after discharge showing physiological FDG-uptake, demonstrating the absence of colitis after tofacitinib. PA: Pathological assessment; CRP: C-reactive protein; ICI: Immune checkpoint inhibitor. Colors indicate severity from green to red.
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Macroscopically, only a mild unspecific colitis with some hemorrhoids was observed ( Figure 1E ). However, the fever and diarrhea persisted, including high levels of C-reactive protein (CRP), an inflammatory marker ( Figures 1A-D ). Prior to the latter administration of vedolizumab, another sigmoidoscopy macroscopically showed a very mild colitis with some ulcers ( Figure 1F ), while microscopically a moderately active colitis with focal apoptosis was described. The prescribed pragmatic broad-spectrum antibiotics did not impact patient's fever or defecation frequency and consistency ( Figures 1C, D ), further supporting the diagnosis of ICI-mediated colitis. A PET-CT scan at day 48 indeed showed the radiological impression of enterocolitis ( Figure 1G ). PET-CT imaging three months after discharge showed an ongoing radiological complete remission of the colitis ( Figure 1H ) and a complete response of all his melanoma metastases.