Presentation
History of metastatic melanoma, status post two cycles of immunotherapy. Third cycle postponed secondary to loose stools.
Patient Data
Lower thorax:
Bilateral pleural effusions with adjacent compressive atelectasis.
Aorta:
Mild calcified atherosclerotic plaque throughout aortoiliac arteries and their branches. The left gastric artery rises directly from the aorta, which is a normal vascular variant.
Gastrointestinal Tract:
There is diffuse low-density wall thickening as well as submucosal enhancement of the ascending, transverse, descending, and rectosigmoid colon with mild surrounding fat stranding. There is a significant amount of intramural edema, most prominent in the cecum and proximal ascending colon. In addition, there is a similar appearing inflammatory process of distal ileum throughout the right lower quadrant with intramural edema and submucosal enhancement.
Bones:
Moderate discovertebral degenerative changes, most prominent at L5-S1 with loss of disc space height and vacuum phenomenon.
General:
Mild ascites is present.
Case Discussion
This case is highly suggestive of pancolitis and distal enteritis caused by ipilimumab, an immunotherapy medication. The patient had a prior study before commencing ipilimumab, which demonstrated metastatic melanoma to the lungs. While the disease burden within the lungs improved after two cycles (not shown on this case), the patient began to experience profuse, watery stools. Ipilimumab is known to cause colitis 1.
Co-authors:
Camille Dumas, DO
Christine Cooley, MD
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