Acute esophageal necrosis induced by immune checkpoint inhibitors

• Published in: Revista española de enfermedades digestivas Vol. 114; no. 3; pp. 182 - 183
• Main Authors: Figuero Pérez, Luis, Olivares-Hernández, Alejandro, Amores-Martín, Arantzazu, Cruz-Hernández, Juan Jesús, Fonseca-Sánchez, Emilio
• Format: Journal Article
• Language: English
• Published: Spain Sociedad Espanola de Patologia Digestivas 01-03-2022
• Subjects: Aged; Esophageal Diseases - pathology; Humans; Immune Checkpoint Inhibitors; Male; Necrosis - chemically induced; Necrosis - diagnosis; Nivolumab - adverse effects
• ISSN: 1130-0108
• DOI: 10.17235/reed.2021.8418/2021

A 73-year-old male with a history of chronic obstructive pulmonary disease and stage IV lung adenocarcinoma, being treated with the PD-1 inhibitor nivolumab, presented to the Emergency Room with a two-day history of coffee ground emesis and melena. On examination, he was tachycardic (130 per minute) and hypotensive (95/55 mmHg). Laboratory studies revealed anemia (6.9 g/dl), leukocytosis and hyper-lactatemia (lactate 6.3 mmol/l). Esophagogastroduodenoscopy was performed which showed diffuse circumferential blackish, necrotic-appearing mucosa of the first third of the esophagus. These findings were consistent with a diagnosis of acute esophageal necrosis (AEN). A biopsy of the esophageal mucosa demonstrated fragments of necrotic tissue with predominant lymphocyte infiltration. He was managed with a strict restriction of oral intake, total parenteral nutrition, double-dose proton pump inhibitors and broad-spectrum antibiotics (piperacillin/tazobactam). Despite the measures adopted, the patient presented a progressive clinical deterioration and died of multiple organ failure 12 days after admission.