Early Administration of Infliximab for Severe Ipilimumab-Related Diarrhea in a Critically Ill Patient
- 20 March 2014
- journal article
- case report
- Published by SAGE Publications in Annals of Pharmacotherapy
- Vol. 48 (6), 806-810
- https://doi.org/10.1177/1060028014528152
Abstract
Objective: To report a case of ipilimumab-associated life-threatening diarrhea responding quickly to a single dose of infliximab. Case Summary: A 67-year-old man presented 3 weeks after his second dose of ipilimumab with severe diarrhea, acute kidney injury, and hypotension. After 2 days of high-dose corticosteroids and supportive care, he continued to have 2.8 L of stool output per day (grade 4 National Cancer Institute Common Terminology Criteria for Adverse Events). The patient was transferred to the medical intensive care unit requiring endotracheal intubation because of concerns of worsening mental status, metabolic acidosis, and increased work of breathing, with a serum bicarbonate concentration of <5 mmol/L. Despite aggressive fluid resuscitation and a sodium bicarbonate infusion, he remained hypotensive and hyponatremic with persistent premature ventricular contractions. On the evening of day 3, infliximab (5 mg/kg) was given, resulting in a rapid decrease in diarrhea. After 48 hours, the acidosis was corrected and electrolytes, renal function, and fluid status were improving. At discharge, diarrhea, acute kidney injury, and acidosis had resolved, and he was discharged on a slow steroid taper. Discussion: Autoimmune colitis is a described immune-related adverse event of ipilimumab. Prompt recognition, initiation of steroids, and supportive therapy are key to the management of diarrhea. Infliximab should be considered early in steroid-nonresponsive or life-threatening diarrhea. Conclusion: Infliximab is a life-saving intervention in patients with ipilimumab-induced diarrhea.Keywords
This publication has 22 references indexed in Scilit:
- Efficacy and safety of ipilimumab in metastatic melanoma patients surviving more than 2 years following treatment in a phase III trial (MDX010-20)Annals Of Oncology, 2013
- Four-year survival rates for patients with metastatic melanoma who received ipilimumab in phase II clinical trialsAnnals of Oncology, 2013
- Ipilimumab and Its Toxicities: A Multidisciplinary ApproachThe Oncologist, 2013
- Cancer statistics, 2013CA: A Cancer Journal for Clinicians, 2013
- Management of Immune-Related Adverse Events and Kinetics of Response With IpilimumabJournal of Clinical Oncology, 2012
- Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992-2006Journal of the American Academy of Dermatology, 2011
- Ipilimumab plus Dacarbazine for Previously Untreated Metastatic MelanomaThe New England Journal of Medicine, 2011
- Improved Survival with Ipilimumab in Patients with Metastatic MelanomaThe New England Journal of Medicine, 2010
- Refractory Colitis Following Anti-CTLA4 Antibody Therapy: Analysis of Mucosal FOXP3+ T CellsDigestive Diseases and Sciences, 2009
- Cytotoxic T-Lymphocyte-Associated Antigen 4 Antibody-Induced Colitis and Its Management with InfliximabDigestive Diseases and Sciences, 2008