Advocate Lutheran General Hospital Park Ridge, IL, United States
Award: Presidential Poster Award
Sufyan AbdulMujeeb, DO1, Ahmed Khattab, MD, MRCP1, Nahren Asado, MD1, Marc Fine, MD2 1Advocate Lutheran General Hospital, Park Ridge, IL; 2Advocate Lutheran General Hospital, Niles, IL
Introduction: Drug-induced colitis (DIC) occurs more often than we encounter. Many cases of DIC go undiagnosed or misdiagnosed due to lack of knowledge of medication side effects. Many chemotherapeutic drugs such as mycophenolate, anti-PD-1, and CTLA-4 inhibitors are well known to cause DIC. We present the first case of DIC associated with an emerging and promising treatment for CD30+ Hodgkin Lymphoma (HL): Brentuximab (Bxb).
Case Description/Methods: A 71-year-old female with a past medical history of CD30+ HL was treated with two rounds of Bxb, doxorubicin, vinblastine, and dacarbazine (AAVD). She complained of severe abdominal pain that started after the 1st dose and worsened after the 2nd dose of the first cycle. She was not neutropenic. CTA demonstrated thickened rectum, sigmoid colon and left colon with patent mesenteric vessels. C difficile and CMV PCR were also negative. Colonoscopy revealed patchy mild inflammation throughout the entire colon, but more pronounced on the left side. Biopsies revealed colonic mucosa with acute cryptitis, crypt microabscesses and scattered apoptotic bodies with a negative CMV histochemical stain. DIC due to Bxb was suspected and it was removed from her AAVD regimen. She reported complete resolution of symptoms with follow up CT revealing resolution of colitis and colonoscopy demonstrated healing of previous ulcers and resolution of inflammation.
Discussion: Bxb is an anti-CD30 antibody that selectively targets cancer cells expressing CD30 on their cell surface. Adverse effects of brentuximab include vomiting, abdominal pain, and diarrhea. Initially, Bxb was approved for HL that had relapsed or failed stem-cell transplant (SCT). However, in 2018 it was approved as a first-line agent for stage III or IV HL. To our knowledge, there is only one other case of Bxb-associated colitis in the literature. It was reported by Parente et al. in a patient who underwent stem cell transplant, making it difficult to differentiate from graft-versus-host-disease. We, therefore, present the first case of brentuximab-induced colitis in a patient with no history of SCT. With expansion of approval of Bxb as a first-line agent for stage III/IV HL, we may encounter more cases of DIC due to Bxb and should, therefore, be cognizant of that complication.
Figure: Figure 1. Colonoscopy image of the left colon showing diffuse erythema, loss of vascularity, and exudates. Figure 2. Multiple discrete shallow ulcers at the rectosigmoid junction. Figure 3. Photomicrograph (10x) demonstrating colonic mucosa with edematous lamina propria (black arrow), acute and chronic inflammatory cell infiltrate (green arrow), and neutrophilic cryptitis (yellow arrow). Figure 4. Higher magnification (20x) showing crypts with crowded enlarged nuclei with mucin loss (red arrows), mitotic figure (blue arrow), and apoptotic bodies (green arrow). Figure 5. Histopathology with a negative CMV stain. Figure 6. Contrast-enhanced CT demonstrating partially collapsed descending and sigmoid colon with mild wall thickening.
Disclosures: Sufyan AbdulMujeeb indicated no relevant financial relationships. Ahmed Khattab indicated no relevant financial relationships. Nahren Asado indicated no relevant financial relationships. Marc Fine indicated no relevant financial relationships.
Sufyan AbdulMujeeb, DO1, Ahmed Khattab, MD, MRCP1, Nahren Asado, MD1, Marc Fine, MD2. P1248 - First Case of Brentuximab-Induced Colitis in a Non-Stem Cell Transplant Patient, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.