Chronic and Severe Non-Lichenoid Oral Ulcers Induced by Nivolumab - Diagnostic and Therapeutic Challenge: A Case Report

Autores organización

• 

  Andres Felipe Cardona Mendoza

  Autor

Autores

• Ruiz-Patiño A
• Ricaurte L
• Zatarain-Barrón ZL
• Barrón F
• Arrieta O

Grupos de investigación

• Grupo de Inmunología celular y molecular Universidad El Bosque (InmuBo)

  Investigador

  Maria Consuelo Romero Sanchez

Resumen

Due to the widespread use of immune checkpoint inhibitors and the growing research efforts in this area, immune-mediated toxicity is well recognized. Nonetheless, few severe cases of oral or upper gastrointestinal tract mucosal involvement have been documented. Early recognition and prompt treatment are key to the adequate management of these patients. We present a male 93-year-old patient with an advanced head and neck tumor treated with nivolumab who developed severe oral ulcers. After discontinuation of nivolumab, he received initial steroid treatment without any significant improvement. Histopathologic analysis of the lesions revealed a pattern similar to graft versus host disease. Extrapolating the results of colchicine mouth washing in patients with active oral ulcers and Behçet's disease, this strategy was implemented with concomitant metronomic cyclophosphamide, achieving complete ulcer resolution. Metagenomic oral bacterial sequencing during instauration of the lesions and highest extension revealed a significant decrease in microbiomic diversity and expansion of Haemophilus parainfluenzae similar to patients with active Behçet's disease. In conclusion, oral ulcers associated with immune checkpoint inhibitors correspond to a difficult-to-treat entity that could physiopathologically be related to both graft versus host disease and Behçet's disease. © 2020 The Author(s). Published by S. Karger AG, Basel.

Copyright © 2020 by S. Karger AG, Basel.

Keywords

• cetuximab; colchicine; cyclophosphamide; etoposide; levothyroxine; methylprednisolone; mouthwash; mugard; nivolumab; prednisone; RNA 16S; sucralfate; thyroid peroxidase antibody; triamcinolone acetonide; aged; Article; bacterium; body weight loss; cancer growth; case report; CD3+ T lymphocyte; CD8+ T lymphocyte; cell population; clinical article; drug tolerance; drug withdrawal; follow up; gastritis; gastroscopy; glossopharyngectomy; graft versus host reaction; Granulicatella; Haemophilus parainfluenzae; high throughput sequencing; histopathology; human; human tissue; hypofractionated radiotherapy; hypothyroidism; intensity modulated radiation therapy; Leptotrichia; lymph node dissection; male; microbial diversity; mouth flora; mouth lesion; mouth squamous cell carcinoma; mouth ulcer; multiple cycle treatment; nucleotide sequence; odynophagia; oral bleeding; pain; pharyngectomy; Porphyromona gingivalis; Prevotella melaninogenica; priority journal; sequence homology; treatment response;