Year 2022 / Volume 114 / Number 3
Letter
Acute esophageal necrosis induced by immune checkpoint inhibitors

182-183

DOI: 10.17235/reed.2021.8418/2021

Luis Figuero Pérez, Alejandro Olivares-Hernández, Arantzazu Amores-Martín, Juan Jesús Cruz-Hernández, Emilio Fonseca-Sánchez,

Abstract
A 73-year-old male with a history of chronic obstructive pulmonary disease and stage IV lung adenocarcinoma, being treated with the PD-1 inhibitor nivolumab, presented to the Emergency Room with a two-day history of coffee ground emesis and melena. On examination, he was tachycardic (130 per minute) and hypotensive (95/55 mmHg). Laboratory studies revealed anemia (6.9 g/dl), leukocytosis and hyper-lactatemia (lactate 6.3 mmol/l). Esophagogastroduodenoscopy was performed which showed diffuse circumferential blackish, necrotic-appearing mucosa of the first third of the esophagus. These findings were consistent with a diagnosis of acute esophageal necrosis (AEN). A biopsy of the esophageal mucosa demonstrated fragments of necrotic tissue with predominant lymphocyte infiltration. He was managed with a strict restriction of oral intake, total parenteral nutrition, double-dose proton pump inhibitors and broad-spectrum antibiotics (piperacillin/tazobactam). Despite the measures adopted, the patient presented a progressive clinical deterioration and died of multiple organ failure 12 days after admission.
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Figuero Pérez L, Olivares-Hernández A, Amores-Martín A, Cruz-Hernández J, Fonseca-Sánchez E. Acute esophageal necrosis induced by immune checkpoint inhibitors. 8418/2021


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Publication history

Received: 25/10/2021

Accepted: 11/11/2021

Online First: 16/11/2021

Published: 07/03/2022

Article revision time: 15 days

Article Online First time: 22 days

Article editing time: 133 days


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