PDF(Pubmed)
Abstract：
A man in his 80s was undergoing immunotherapy with pembrolizumab, an anti-PD-1 monoclonal antibody, following his diagnosis of adenocarcinoma of primary lung origin. 24 weeks into treatment, the patient reported experiencing loose stools associated with malaise and poor appetite but no further symptoms. This progressed in frequency and a clinical diagnosis of grade 2 immune checkpoint inhibitor colitis was made. Management with oral prednisolone was commenced but symptoms persisted. Common enteric infections had been ruled out, as were coeliac disease and hyperthyroidism. Flexible sigmoidoscopy and colonoscopy results were not in keeping with colitis, having revealed normal looking mucosa. Following this, a faecal elastase level was found to be low. A diagnosis of pembrolizumab-induced pancreatic exocrine insufficiency was made, and stool frequency and consistency swiftly improved following the use of pancreatic enzyme replacement therapy.
摘要：
一名80多岁的男子正在接受派姆单抗的免疫疗法，抗PD-1单克隆抗体,在他诊断为原发性肺源性腺癌后。治疗24周，患者报告出现与不适和食欲不振相关的稀便，但没有进一步的症状。这在频率上进展,并且做出2级免疫检查点抑制剂结肠炎的临床诊断。开始口服泼尼松龙治疗，但症状持续存在。常见的肠道感染已被排除,乳糜泻和甲状腺功能亢进也是如此。软式乙状结肠镜和结肠镜检查结果与结肠炎不一致，粘膜看起来正常。在此之后,发现粪便弹性蛋白酶水平较低。诊断为pembrolizumab诱导的胰腺外分泌功能不全，使用胰酶替代疗法后，粪便频率和稠度迅速改善。
