An Unusual Etiology of Celiac Duodenopathy

Abstract

Immune checkpoint inhibitors (ICPI) are an evolving therapy for treating various malignancies. However, as their use increases in medical management, the associated side effects become more prominent. These immune-related adverse events can include gastrointestinal complications and exacerbation of autoimmune disorders. Diarrhea is a commonly reported side effect in the literature, and colitis or enterocolitis are also frequently noted. Although current management is mainly symptomatic treatment, discontinuing immunotherapy is necessary if symptoms become severe. This case report presents a patient who started on Pembrolizumab therapy and subsequently developed abdominal pain and nausea. Endoscopic biopsy findings suggest Celiac duodenopathy, and treatment with steroids and dietary modifications helped improve symptoms. It is important to note that ICPIs can induce autoimmune phenomena, including those affecting the small bowel. Therefore, a high index of suspicion is necessary when patients present with gastrointestinal symptoms during or after ICPI therapy. Close monitoring of patients on ICPI therapy is crucial to identify and manage any potential side effects promptly.