Año 2025 / Volumen 117 / Número 8
Carta
Management of cytomegalovirus reactivation in a patient with immunotherapy-induced gastritis

472-473

DOI: 10.17235/reed.2024.10550/2024

Samuel Robles Gaitero, Jorge del Río-Fernández, Sagrario María Santos-Seoane, Teresa Sampedro-Gimeno, Javier Tejedor-Tejada, Ana Villar Caamaño, Cristina Camblor, Cristina Menéndez Sánchez,

Resumen
We present the case of a 52-year-old woman diagnosed with stage IV clear cell renal cell carcinoma who received combination of surgery and systemic therapy with nivolumab (anti-PD1) and ipilimumab (anti-CTLA-4). During treatment, patient presented oral intolerance, vomiting and abdominal pain. Computed tomography (CT) and gastroscopy (EGD) were performed, identifying findings suggestive of severe gastro-duodenitis with friability and diffuse oedema of the mucosa and deep ulcers. A gastrointestinal immunotherapy-induced toxicity was suspected so patient was managed with proton pump inhibitors (PPIs) and intravenous corticosteroids 1mg/Kg. Three weeks later, corticosteroid treatment failed. EGD was repeated and gastric biopsies were taken for histological and microbiological tests. Gastric biopsies revealed the presence of cytomegalovirus (CMV) inclusion bodies by immunohistochemistry (IHC). CMV viral load by quantitative PCR in plasma was 2,000 IU/mL so intravenous ganciclovir was prescribed. Then, the patient presented poor clinical course with persistent vomiting due to a failure of first-line corticosteroid and antiviral treatment. Another EGD was performed. Last IHC reveals a low CMV viral load. Second-line treatment with Anti-TNF was performed using a single-dose regimen of intravenous infliximab 5 mg/Kg. Finally, the patient presented a clinical and endoscopic response and a negative CMV DNA test in the blood after completing the antiviral treatment.
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Bibliografía
1. Iranzo I, Huguet JM, Suárez P, et al. Endoscopic evaluation of immunotherapy-induced gastrointestinal toxicity. World J Gastrointest Endosc. 2018 Dec 16;10(12):392-399. doi: 10.4253/wjge.v10.i12.392. PMID: 30631403; PMCID: PMC6323501.
2. Paredes-Ruiz D, López-López F, Núñez-Sobrino JA, et al. Reactivación de citomegalovirus en pacientes con gastritis inmunomediada [Cytomegalovirus reactivation in patients with immune-mediated gastritis]. Enferm Infecc Microbiol Clin (Engl Ed). 2023 May;41(5):298-300. Spanish. doi: 10.1016/j.eimce.2022.03.017. Epub 2023 Jan 19. PMID: 36681573.
3. Riveiro-Barciela M, Carballal S, Díaz-González Á, et al. Management of liver and gastrointestinal toxicity induced by immune checkpoint inhibitors: Position statement of the AEEH-AEG-SEPD-SEOM-GETECCU. Gastroenterol Hepatol. 2024 Apr;47(4):401-432. English, Spanish. doi: 10.1016/j.gastrohep.2023.10.009. Epub 2024 Jan 15. PMID: 38228461.
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Instrucciones para citar
Robles Gaitero S, del Río-Fernández J, Santos-Seoane S, Sampedro-Gimeno T, Tejedor-Tejada J, Villar Caamaño A, et all. Management of cytomegalovirus reactivation in a patient with immunotherapy-induced gastritis. 10550/2024


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Ficha Técnica

Recibido: 18/05/2024

Aceptado: 23/05/2024

Prepublicado: 04/06/2024

Publicado: 24/07/2025

Tiempo de prepublicación: 17 días

Tiempo de edición del artículo: 432 días


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