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Refractory pembrolizumab immunotherapy-related colitis requiring biological therapy in an inactive HBcAb carrier
  1. Nidaa Rasheed1,
  2. Rajan Anand2,
  3. Mark Maddox3 and
  4. Candice Reyes4
  1. 1Internal Medicine, University of California San Francisco, Fresno, California, USA
  2. 2Department of Gastroenterology, University of California San Francisco Fresno, Fresno, California, USA
  3. 3Department of Medical Oncology, Duke University Medical Center, Durham, North Carolina, USA
  4. 4Department of Rheumatology, University of California San Francisco, Fresno, California, USA
  1. Correspondence to Nidaa Rasheed; nidaa.rasheed{at}


Immune checkpoint inhibitors are a class of cancer immunotherapy, with a constellation of side effects that require early recognition and management. We present a patient with metastatic adenocarcinoma started on pembrolizumab a month prior, who was admitted to the hospital for bloody diarrhoea. He underwent flexible sigmoidoscopy with biopsy proven grade 3 immune-mediated diarrhoea and colitis. He developed progressively worsening diarrhoea despite appropriate intravenous corticosteroids therapy, and initiation of corticosteroid-sparing therapy was complicated by discovery of hepatitis B core antibodies indicating a chronic hepatitis B carrier state. We discuss our work-up of new onset haemorrhagic diarrhoea in a patient on immunotherapy for metastatic non-small cell lung cancer, as well as a review of current guidelines for antiviral prophylaxis in these patients.

  • Gastrointestinal system
  • Malignant disease and immunosuppression
  • GI bleeding
  • Hepatitis B

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: NR, MM, RA and CR. The following authors gave final approval of the manuscript: NR, MM, RA and CR.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.